Provider Demographics
NPI:1356446520
Name:DENHEIJER, LAUREL L (APNP)
Entity type:Individual
Prefix:
First Name:LAUREL
Middle Name:L
Last Name:DENHEIJER
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:LAUREL
Other - Middle Name:L
Other - Last Name:SICKINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APNP
Mailing Address - Street 1:PO BOX 22487
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-2487
Mailing Address - Country:US
Mailing Address - Phone:920-445-7226
Mailing Address - Fax:920-445-7289
Practice Address - Street 1:923 ELIZA ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-3234
Practice Address - Country:US
Practice Address - Phone:920-965-4800
Practice Address - Fax:920-965-4801
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1597-33363LF0000X
WI1597003363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43983000Medicaid
0342125OtherAMERICAN NURSES CREDENTIALING CENTER
000042Medicare Oscar/Certification
000023Medicare Oscar/Certification
000005Medicare Oscar/Certification
WI000004Medicare Oscar/Certification
000039Medicare Oscar/Certification
Q50725Medicare UPIN
WI43983000Medicaid
WI0039Medicare PIN