Individual
MS. LORELLE PATRICIA KIECKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
507 N 17TH ST, MILWAUKEE, WI 53233
(715) 781-9731
Mailing address
507 N 17TH ST, MILWAUKEE, WI 53233
(715) 781-9731
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
7042-23
WI
Other
Enumeration date
02/24/2022
Last updated
03/11/2023
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