Provider Demographics
NPI:1891986444
Name:FLEGEL, LAURI ANNE (LPN)
Entity Type:Individual
Prefix:
First Name:LAURI
Middle Name:ANNE
Last Name:FLEGEL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3447 EISNER CT APT D
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53083-2922
Mailing Address - Country:US
Mailing Address - Phone:920-980-4582
Mailing Address - Fax:
Practice Address - Street 1:3447 EISNER CT APT D
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53083-2922
Practice Address - Country:US
Practice Address - Phone:920-980-4582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38349500Medicaid