Active NPI
Laura Jane Mamerow, RD
- Registered Dietitian
- Oconomowoc, WI
National Provider Identifier
1073021820
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 1064986
- Practice address
- W2312 W Schure Dr
Oconomowoc, WI 53066-9322 - Phone
- (920) 470-7374
- NPI assigned
- Jan 15, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 1064986 | WI | Primary |
Addresses
Primary practice location
W2312 W Schure Dr
Oconomowoc, WI 53066-9322
Mailing address
901 S Whitney Way
Madison, WI 53711-2553
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1064986 | WI | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1515974400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1619740800000",
"number": "1073021820",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "901 S WHITNEY WAY",
"city": "MADISON",
"state": "WI",
"postal_code": "537112553"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "W2312 W SCHURE DR",
"city": "OCONOMOWOC",
"state": "WI",
"postal_code": "530669322",
"telephone_number": "920-470-7374"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAMEROW",
"first_name": "LAURA",
"middle_name": "JANE",
"credential": "RD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-01-15",
"last_updated": "2021-04-30",
"certification_date": "2021-04-30",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "WI",
"license": "1064986",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oconomowoc, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.