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Lakeside Family Practice
Gerontology Nurse Practitioner in Kenosha, Wisconsin
NPI 1831698430

Lakeside Family Practice is a Gerontology Nurse Practitioner based in Waukesha, WI and is specialized in Gerontology. Lakeside Family Practice practices in Kenosha, WI. The NPI Number for Lakeside Family Practice is 1831698430 and holds a License No. 2011006054 (Wisconsin).

The current practice location address for Lakeside Family Practice is 3200 Sheridan Rd Ste 104, Kenosha, WI and can be reached out via phone at 262-225-1014.

Location: 3200 Sheridan Rd Ste 104, Kenosha, WI, 53188-2606
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1831698430
Provider Name
Lakeside Family Practice
Credential
Provider Entity Type
Organization
Address
3200 Sheridan Rd Ste 104, Kenosha, WI, 53188-2606
Phone Number
262-225-1014
Fax Number
Provider Enumeration Date
02/08/2018
Last Update Date
03/13/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
100043522 05 WI
100018824 05 WI
institution
Provider Business Practice Location Address Details
Address
3200 Sheridan Rd Ste 104
City
Kenosha
State
Wisconsin
Zip
53140-1921
Phone Number
262-225-1014
Fax Number
person
Provider Business Mailing Address Details
Address
3200 Sheridan Rd Ste 104
City
Kenosha
State
Wisconsin
Zip
53140-1921
Phone Number
262-225-1014
Fax Number
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Nurse Practitioner
Speciality
Family
Taxonomy
363LF0000X
License No.
6190-33 (Wisconsin)
Definition
Definition to come...
person
Provider's Taxonomy Details 2
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Nurse Practitioner
Speciality
Gerontology
Taxonomy
363LG0600X
License No.
2011006054 (Wisconsin)
Definition
Definition to come...
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