Provider Demographics
NPI:1386025146
Name:WIMMER, LAURA LASECKI (DPM)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:LASECKI
Last Name:WIMMER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23937 US HIGHWAY 98 STE 1
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-3354
Mailing Address - Country:US
Mailing Address - Phone:251-928-6768
Mailing Address - Fax:251-517-0501
Practice Address - Street 1:23937 US HIGHWAY 98 STE 1
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532
Practice Address - Country:US
Practice Address - Phone:251-458-0322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-17
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL135000868213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery