Provider Demographics
NPI:1760626360
Name:MUSOLF, LAURA M (NP)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:M
Last Name:MUSOLF
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:M
Other - Last Name:THIMMESCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9000 W WISCONSIN AVE
Mailing Address - Street 2:PEDIATRIC OTOLARYNGOLOGY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4874
Mailing Address - Country:US
Mailing Address - Phone:414-266-6460
Mailing Address - Fax:414-266-2693
Practice Address - Street 1:9000 W WISCONSIN AVE
Practice Address - Street 2:PEDIATRIC OTOLARYNGOLOGY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4874
Practice Address - Country:US
Practice Address - Phone:414-266-6460
Practice Address - Fax:414-266-2693
Is Sole Proprietor?:No
Enumeration Date:2009-04-27
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI139387363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1760626360Medicaid
WI736011459Medicare PIN