Provider Demographics
NPI:1609978196
Name:WHORLEY, LAURIE ANN (APNP)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:ANN
Last Name:WHORLEY
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:MS
Other - First Name:LAURIE
Other - Middle Name:ANN
Other - Last Name:GEREAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APNP
Mailing Address - Street 1:S69W15636 JANESVILLE RD
Mailing Address - Street 2:
Mailing Address - City:MUSKEGO
Mailing Address - State:WI
Mailing Address - Zip Code:53150-9330
Mailing Address - Country:US
Mailing Address - Phone:262-928-7000
Mailing Address - Fax:414-422-2079
Practice Address - Street 1:S69W15636 JANESVILLE RD
Practice Address - Street 2:
Practice Address - City:MUSKEGO
Practice Address - State:WI
Practice Address - Zip Code:53150-9330
Practice Address - Country:US
Practice Address - Phone:262-928-7000
Practice Address - Fax:414-422-2079
Is Sole Proprietor?:No
Enumeration Date:2006-09-04
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2944363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI68375Medicare PIN
WI36017100Medicaid
WI1609978196Medicaid
WI044U 73-601Medicare PIN