Provider Demographics
NPI:1689607004
Name:RUNTE, LAUREL J (APNP)
Entity Type:Individual
Prefix:
First Name:LAUREL
Middle Name:J
Last Name:RUNTE
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 MCMILLEN ST
Mailing Address - Street 2:
Mailing Address - City:FORT ATKINSON
Mailing Address - State:WI
Mailing Address - Zip Code:53538-1996
Mailing Address - Country:US
Mailing Address - Phone:920-563-5500
Mailing Address - Fax:920-563-4472
Practice Address - Street 1:426 MCMILLEN ST
Practice Address - Street 2:
Practice Address - City:FORT ATKINSON
Practice Address - State:WI
Practice Address - Zip Code:53538-1996
Practice Address - Country:US
Practice Address - Phone:920-563-5500
Practice Address - Fax:920-563-4472
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI87913-030163W00000X
WI543-33363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43841100Medicaid
WIMR0202399OtherDEA
WI303450190Medicare PIN
WIMR0202399OtherDEA