Provider Demographics
NPI:1720215353
Name:OZIMEK, LAURA M (PA-C)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:M
Last Name:OZIMEK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13800 W NORTH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-4977
Mailing Address - Country:US
Mailing Address - Phone:262-754-4488
Mailing Address - Fax:262-754-4940
Practice Address - Street 1:13800 W NORTH AVE STE 100
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-4977
Practice Address - Country:US
Practice Address - Phone:262-754-4488
Practice Address - Fax:262-754-4940
Is Sole Proprietor?:No
Enumeration Date:2009-06-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2419363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIMR1971488OtherDEA