Provider Demographics
NPI:1851487540
Name:CLABOTS, ANN M (ANP)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:M
Last Name:CLABOTS
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9601 TOWNLINE RD
Mailing Address - Street 2:
Mailing Address - City:MINOCQUA
Mailing Address - State:WI
Mailing Address - Zip Code:54548-9099
Mailing Address - Country:US
Mailing Address - Phone:715-358-1811
Mailing Address - Fax:715-358-1188
Practice Address - Street 1:9601 TOWNLINE RD
Practice Address - Street 2:
Practice Address - City:MINOCQUA
Practice Address - State:WI
Practice Address - Zip Code:54548-9099
Practice Address - Country:US
Practice Address - Phone:715-358-1811
Practice Address - Fax:715-358-1188
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2017-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2137033363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43983200Medicaid
WI008300234Medicare ID - Type Unspecified