Provider Demographics
NPI:1215012117
Name:SPERLE, LAURA LEE (RN)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:LEE
Last Name:SPERLE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:LAURA
Other - Middle Name:LEE
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:N 8015 NICKY CT
Mailing Address - Street 2:
Mailing Address - City:EAST TROY
Mailing Address - State:WI
Mailing Address - Zip Code:53120
Mailing Address - Country:US
Mailing Address - Phone:262-642-5984
Mailing Address - Fax:
Practice Address - Street 1:N 8015 NICKY CT
Practice Address - Street 2:
Practice Address - City:EAST TROY
Practice Address - State:WI
Practice Address - Zip Code:53120
Practice Address - Country:US
Practice Address - Phone:262-642-5984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39985400Medicaid