Provider Demographics
NPI:1689675563
Name:LAEVEN-SESSIONS, PETRA M (MD)
Entity Type:Individual
Prefix:
First Name:PETRA
Middle Name:M
Last Name:LAEVEN-SESSIONS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PETRA
Other - Middle Name:M
Other - Last Name:MESSICK-LAEVEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:130 2ND ST
Mailing Address - Street 2:PEDIATRIC HOSPITALIST DEPT
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-2883
Mailing Address - Country:US
Mailing Address - Phone:920-969-7900
Mailing Address - Fax:920-969-7979
Practice Address - Street 1:130 2ND ST
Practice Address - Street 2:PEDIATRIC HOSPITALIST DEPT
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-2883
Practice Address - Country:US
Practice Address - Phone:920-969-7900
Practice Address - Fax:920-969-7979
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT9639208000000X
WI62317-20208000000X
WAMD60147163208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2011936Medicaid
WI1689675563Medicaid
MT0028424Medicaid
WA2011936Medicaid