Basic Information
| Provider Information | |||||||||
| NPI: | 1588081913 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | O'LOUGHLIN | ||||||||
| FirstName: | LAURA | ||||||||
| MiddleName: | W | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | APNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4425 N PORT WASHINGTON RD | ||||||||
| Address2: | CSMCP CLINIC CREDENTIALING | ||||||||
| City: | GLENDALE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532121082 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4143262218 | ||||||||
| FaxNumber: | 4143262208 | ||||||||
| Practice Location | |||||||||
| Address1: | 2311 N PROSPECT AVE | ||||||||
| Address2: | PROSPECT MEDICAL COMMONS | ||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532114445 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4143193000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2014 | ||||||||
| LastUpdateDate: | 05/15/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 5641 | WI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.