Provider Demographics
NPI:1477540888
Name:LADURON, MICHELE ANN (APNP)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:ANN
Last Name:LADURON
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:ANN
Other - Last Name:MUEHLBERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:340 N GREEN BAY AVE
Mailing Address - Street 2:
Mailing Address - City:GILLETT
Mailing Address - State:WI
Mailing Address - Zip Code:54124-9325
Mailing Address - Country:US
Mailing Address - Phone:920-855-2823
Mailing Address - Fax:920-855-6343
Practice Address - Street 1:340 N GREEN BAY AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:GILLETT
Practice Address - State:WI
Practice Address - Zip Code:54124-9325
Practice Address - Country:US
Practice Address - Phone:920-855-2823
Practice Address - Fax:920-855-6343
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1075-033363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI390848401050OtherCMH ANTHEM
WI11014110Medicaid
WI1851477913OtherCMH NPI
WI1134250905OtherGPCC NPI
S65398Medicare UPIN
WI521310Medicare Oscar/Certification