Provider Demographics
NPI:1811977929
Name:SMITH, LAURA ANN (DO)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3085 MEADOWLARK LN
Mailing Address - Street 2:STE 20
Mailing Address - City:ALTOONA
Mailing Address - State:WI
Mailing Address - Zip Code:54720-2656
Mailing Address - Country:US
Mailing Address - Phone:715-717-3350
Mailing Address - Fax:
Practice Address - Street 1:3085 MEADOWLARK LN STE 20
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:WI
Practice Address - Zip Code:54720
Practice Address - Country:US
Practice Address - Phone:715-717-3350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI50311-021208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIK400119717Medicare Oscar/Certification