Individual provider Active NPI

Nicole Laabs, PA-C

  • Physician Assistant
  • Milwaukee, WI
National Provider Identifier
1942519418
Registry record updated Nov 8, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
2677-23 Issued in WI
Practice address
2555 N Martin Luther King Dr
Milwaukee, WI 53212-2709
Phone
(414) 267-2080
Fax
(414) 267-8570
NPI assigned
Oct 1, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2016

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 2677-23 WI Primary

Addresses

Primary practice location

2555 N Martin Luther King Dr
Milwaukee, WI 53212-2709

Mailing address

2555 N Martin Luther King Dr
Milwaukee, WI 53212-2709
Phone (414) 267-2080

Other identifiers 1

IdentifierTypeStateIssuer
K400308317OtherWIMEDICARE PTAN

Other names 1

  • Nicole Miller Other 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
I20110311000722 WI Practitioner - Physician Assistant 9133301112 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Horizon Healthcare, IncGroup PAC ID 0749182160, 15 clinicians

Practice addresses (Care Compare)

4650 S Howell Ave
Milwaukee, WI 53207-5908
Phone (414) 376-5577

5408 W Burleigh St
Milwaukee, WI 53210-1624
Phone (414) 362-8147

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2677-23WIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Horizon Healthcare, Inc CurrentSince Mar 22, 2021 Accepting new patients
Milwaukee Health Services Inc CurrentSince Jul 18, 2016 Accepting new patients
Milwaukee Health Services, Inc. CurrentSince Jul 18, 2016 Accepting new patients

Locations

3410 80th St
Kenosha, WI 53142
Phone (262) 697-0825

5408 W Burleigh St
Milwaukee, WI 53210
Phone (414) 445-6520

2819 W Highland Blvd
Milwaukee, WI 53208
Phone (414) 939-7145

4650 S Howell Ave
Milwaukee, WI 53207
Phone (414) 294-0144

2835 N 32nd St
Milwaukee, WI 53210
Phone (414) 342-6200

2555 N Mlk Dr
Milwaukee, WI 53212
Phone (414) 267-2022

835 Wisconsin Ave
Racine, WI 53403

Organizations & group practices 6

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": "1285891200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1478563200000",
    "number": "1942519418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2555 N MARTIN LUTHER KING DR",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532122709",
            "telephone_number": "414-267-2080",
            "fax_number": "414-267-8570"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2555 N MARTIN LUTHER KING DR",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532122709",
            "telephone_number": "414-267-2080",
            "fax_number": "414-267-8570"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAABS",
        "first_name": "NICOLE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-10-01",
        "last_updated": "2016-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "2677-23",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "K400308317",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NICOLE",
            "last_name": "MILLER",
            "credential": "PA-C",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Milwaukee, WI

Sources for this page

Verify at the official NPI Registry.