Provider Demographics
NPI:1700195567
Name:BAEHNMAN, LAURA L (APNP)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:L
Last Name:BAEHNMAN
Suffix:
Gender:F
Credentials:APNP
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Mailing Address - Street 1:100 THEDA CLARK MEDICAL PLZ STE 400
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-2763
Mailing Address - Country:US
Mailing Address - Phone:920-725-4527
Mailing Address - Fax:920-729-2378
Practice Address - Street 1:N2934 STATE ROAD 22
Practice Address - Street 2:
Practice Address - City:WAUTOMA
Practice Address - State:WI
Practice Address - Zip Code:54982-5267
Practice Address - Country:US
Practice Address - Phone:920-787-4613
Practice Address - Fax:920-787-5433
Is Sole Proprietor?:No
Enumeration Date:2010-09-28
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI4203-33364SM0705X
WI4203363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SM0705XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistMedical-Surgical