institution
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. You can also correspond with Lakeside Family Practice through the mailing address at 2113 TALLGRASS CIR, WAUKESHA, WI - 53188-2606 (mailing address contact number: 262-225-1014).

Location: 3200 Sheridan Rd Ste 104, Kenosha, WI, 53188-2606
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
State
Zip
53140-1921
Phone Number
262-225-1014
Fax Number
person
Provider Business Mailing Address Details
Address
3200 Sheridan Rd Ste 104
City
State
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
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
License No.
2011006054 (Wisconsin)
Definition
Definition to come...
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