Provider Demographics
NPI:1649547415
Name:WILHEM MANLEY, LAURA ELIZABETH (APRN)
Entity type:Individual
Prefix:MISS
First Name:LAURA
Middle Name:ELIZABETH
Last Name:WILHEM MANLEY
Suffix:
Gender:F
Credentials:APRN
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Mailing Address - Street 1:9800 SHELBYVILLE RD STE 220
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-2992
Mailing Address - Country:US
Mailing Address - Phone:502-429-8585
Mailing Address - Fax:502-429-6157
Practice Address - Street 1:9113 LEESGATE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-5003
Practice Address - Country:US
Practice Address - Phone:502-426-1621
Practice Address - Fax:502-426-7906
Is Sole Proprietor?:No
Enumeration Date:2011-11-22
Last Update Date:2021-05-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY3007248363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3007248OtherKENTUCKY LICENSE