Provider Demographics
NPI:1275831513
Name:BENKLEY, LAURIE BD (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:BD
Last Name:BENKLEY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 E MORELAND BLVD
Mailing Address - Street 2:WESTBROOK WALK-IN CLINIC
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-2939
Mailing Address - Country:US
Mailing Address - Phone:262-532-5800
Mailing Address - Fax:262-532-5760
Practice Address - Street 1:2315 E MORELAND BLVD
Practice Address - Street 2:WESTBROOK WALK-IN CLINIC
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-2939
Practice Address - Country:US
Practice Address - Phone:262-532-5800
Practice Address - Fax:262-532-5760
Is Sole Proprietor?:No
Enumeration Date:2011-03-10
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI94365-03163W00000X
WI4223-033363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1275831513Medicaid