Organization
MISSING LYNX LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. REBECCA R RUSS NP (DIRECTOR)
(414) 803-6310
Entity
Organization
Contact information
Practice address
11031 W FAIRLANE AVE, MILWAUKEE, WI 53224-2585
(414) 803-6310
Mailing address
11031 W FAIRLANE AVE, MILWAUKEE, WI 53224-2585
(414) 803-6310
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Enumeration date
05/19/2021
Last updated
05/19/2021
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