Basic Information
Provider Information | |||||||||
NPI: | 1992399067 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | PFLUGHOEFT | ||||||||
FirstName: | COURTNEY | ||||||||
MiddleName: | LAUREN | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | APNP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | CORNELLA-CARLSON | ||||||||
OtherFirstName: | COURTNEY | ||||||||
OtherMiddleName: | LAUREN | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | PMHNP | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 34700 VALLEY RD | ||||||||
Address2: |   | ||||||||
City: | OCONOMOWOC | ||||||||
State: | WI | ||||||||
PostalCode: | 530664500 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2626464411 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 34700 VALLEY RD | ||||||||
Address2: |   | ||||||||
City: | OCONOMOWOC | ||||||||
State: | WI | ||||||||
PostalCode: | 530664500 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2626464411 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/01/2021 | ||||||||
LastUpdateDate: | 03/22/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 03/22/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 10762-33 | WI | N |   | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 363L00000X | 10762 | WI | N |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |   | 363LP0808X | 10762 | WI | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.