Provider Demographics
NPI:1538638655
Name:EVANS, LAUREL L (APNP)
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:L
Last Name:EVANS
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:LAUREL
Other - Middle Name:
Other - Last Name:SEAMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2301 SUN VALLEY DR STE 300
Mailing Address - Street 2:
Mailing Address - City:DELAFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53018-2318
Mailing Address - Country:US
Mailing Address - Phone:262-928-4043
Mailing Address - Fax:
Practice Address - Street 1:2301 SUN VALLEY DR STE 300
Practice Address - Street 2:
Practice Address - City:DELAFIELD
Practice Address - State:WI
Practice Address - Zip Code:53018-2318
Practice Address - Country:US
Practice Address - Phone:262-928-4043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-19
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8781363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily