Individual
MISS KAWANA LATRICE HICKMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
3423 N 57TH ST, MILWAUKEE, WI 53216-2842
(414) 828-7202
Mailing address
PO BOX 100442, MILWAUKEE, WI 53210-0442
(414) 828-7202
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
302249-031
WI
Other
Enumeration date
04/03/2006
Last updated
10/05/2012
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