Provider Demographics
NPI:1578016143
Name:TYLER, LAUREN TAUBENSEE HAVEY (AGACNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:LAUREN
Middle Name:TAUBENSEE HAVEY
Last Name:TYLER
Suffix:
Gender:F
Credentials:AGACNP-BC
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2901 W KK RIVER PKWY STE 315
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-3660
Mailing Address - Country:US
Mailing Address - Phone:414-649-5646
Mailing Address - Fax:414-649-6282
Practice Address - Street 1:2901 W KINNICKINNIC RIVER PKWY
Practice Address - Street 2:SUITE 315
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-3677
Practice Address - Country:US
Practice Address - Phone:414-385-4638
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-29
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI7074363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner