Provider Demographics
NPI:1992357982
Name:ACKERMAN, LAUREN ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:ANN
Last Name:ACKERMAN
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 1:788 N JEFFERSON ST STE 300
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-3710
Mailing Address - Country:US
Mailing Address - Phone:414-272-8950
Mailing Address - Fax:414-274-6250
Practice Address - Street 1:3501 E RAMSEY AVE
Practice Address - Street 2:
Practice Address - City:CUDAHY
Practice Address - State:WI
Practice Address - Zip Code:53110-3009
Practice Address - Country:US
Practice Address - Phone:414-647-7170
Practice Address - Fax:414-662-2507
Is Sole Proprietor?:No
Enumeration Date:2019-07-10
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4771-23363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1992357982Medicaid