Provider Demographics
NPI:1710604061
Name:BRADSTREET, LAURA J (APNP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:J
Last Name:BRADSTREET
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:619 WINDLACH ST
Mailing Address - Street 2:
Mailing Address - City:NEW GLARUS
Mailing Address - State:WI
Mailing Address - Zip Code:53574-9439
Mailing Address - Country:US
Mailing Address - Phone:414-412-0427
Mailing Address - Fax:
Practice Address - Street 1:619 WINDLACH ST
Practice Address - Street 2:
Practice Address - City:NEW GLARUS
Practice Address - State:WI
Practice Address - Zip Code:53574-9439
Practice Address - Country:US
Practice Address - Phone:414-412-0427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-26
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13111363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics