Individual provider Active NPI

Laura L Spychalla, PAC

  • Physician Assistant
  • Milwaukee, WI
National Provider Identifier
1922342591
Registry record updated May 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
3007 Issued in WI
Practice address
9000 W Wisconsin Ave
Pediatric Neurology
Milwaukee, WI 53226-4874
Phone
(414) 266-3464
Fax
(414) 266-3466
NPI assigned
Nov 20, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 19, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 3007 WI Primary

Addresses

Primary practice location

9000 W Wisconsin Ave
Pediatric Neurology
Milwaukee, WI 53226-4874

Mailing address

9000 W Wisconsin Ave
Pediatric Neurology
Milwaukee, WI 53226-4874
Phone (414) 266-3464

Other practice location 1

2575 E Evergreen Drive
Appleton, WI 54913-8904
Phone (920) 969-5353

Other practice location 2

4855 S Moorland Rd
New Berlin, WI 53151-7494
Phone (414) 607-5280

Other identifiers 1

IdentifierTypeStateIssuer
1922342591MedicaidWI

Other names 1

  • Laura L Paquet Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130411000139 WI Practitioner - Physician Assistant 3577709880 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
3007WIMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Children's Specialty Group, Inc. Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: lpaquet21660@direct.chw.org

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1353369600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684454400000",
    "number": "1922342591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9000 W WISCONSIN AVE",
            "address_2": "PEDIATRIC NEUROLOGY",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532264874",
            "telephone_number": "414-266-3464",
            "fax_number": "414-266-3466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9000 W WISCONSIN AVE",
            "address_2": "PEDIATRIC NEUROLOGY",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532264874",
            "telephone_number": "414-266-3464",
            "fax_number": "414-266-3466"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2575 E EVERGREEN DRIVE",
            "address_purpose": "LOCATION",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549138904",
            "country_code": "US",
            "telephone_number": "920-969-5353",
            "fax_number": "414-337-7201",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4855 S Moorland Rd",
            "address_purpose": "LOCATION",
            "city": "New Berlin",
            "state": "WI",
            "postal_code": "531517494",
            "country_code": "US",
            "telephone_number": "414-607-5280",
            "fax_number": "414-607-5288",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SPYCHALLA",
        "first_name": "LAURA",
        "middle_name": "L",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-11-20",
        "last_updated": "2023-05-19",
        "certification_date": "2023-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "3007",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1922342591",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LAURA",
            "last_name": "PAQUET",
            "middle_name": "L",
            "credential": "PAC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.