Laura B Pethan, APNP
Individual provider Active NPI Pediatric Nurse Practitioner · Sun Prairie, WI
NPI 1194122861 · NPPES record last updated Apr 24, 2020
Key facts
- NPI
- 1194122861
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatric Nurse Practitioner 363LP0200X
- License
- 7462-33 (WI)
- Practice address
- 10 Tower Dr
Sun Prairie, WI 53590-1239 - Phone
- (608) 825-3008
- Fax
- (608) 825-3786
- NPI assigned
- Nov 25, 2014
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170222002261 | WI | Practitioner - Nurse Practitioner | 6608199526 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7462 | WI | MD | Addiction (Substance Use Disorder) Counselor |
| 7462-33 | WI | MD | Pediatric Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bellin Memorial Hospital Inc | Current | Accepting new patients | |
| Bellin Memorial Hospital Inc | Current |
Accepting new patients | |
| Bellin Memorial Hospital Inc | Current |
Accepting new patients | |
| Bellin Memorial Hospital Inc | Past | Accepting new patients |
Locations
555 Redbird Cir
Ste 300
De Pere, WI 54115
Phone (920) 338-6830
555 Redbird Cir
De Pere, WI 54115
Phone (920) 338-6820
744 S Webster Ave
Green Bay, WI 54301
Phone (920) 433-6025
Interoperability endpoints
- lpethan926174@direct.emplifyhealth.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Nurse Practitioner | 363LP0200X | 7462-33 | WI | Yes |
Addresses
Primary practice location
10 Tower Dr
Sun Prairie, WI 53590-1239
Mailing address
PO Box 22487
Green Bay, WI 54305-2487
Phone (920) 445-7222
Other practice location 1
555 Redbird Cir
DE Pere, WI 54115-7977
Phone (920) 338-6820
Other names
- Laura B Scharenbroch
Other providers in Sun Prairie, WI
- Performance Rehab and Chiropractic, Inc.
- Christopher D Peters
- Kameron Peterson
- Stephanie Mt Peterson
- Tina D Peterson
- Robert T. Peyton
- Amy Rose Phillips
- Phoenix Counseling, LTD
- Jonathon Michael Pinnow
- Stephanie Pinnow
All providers in Sun Prairie, WI · Pediatric Nurse Practitioner in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 24, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.