Individual
KRISTIN M LAVENHAGEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
331 E PUETZ RD, LAKESHORE MEDICAL CLINIC, OAK CREEK, WI 53154-3253
(414) 570-3590
Mailing address
100 15TH AVENUE, LAKESHORE MEDICAL CLINIC, SOUTH MILWAUKEE, WI 53172-1160
(414) 768-5430
(414) 762-4225
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2636-23
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2636-23
WISCONSIN LICENSE
WI
Enumeration date
08/05/2010
Last updated
09/28/2012
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