Individual
MARY R LAQUERRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AA
Contact information
Practice address
2323 N LAKE DR, MILWAUKEE, WI 53211-4508
(414) 291-1000
(414) 291-1113
Mailing address
225 S EXECUTIVE DR, BROOKFIELD, WI 53005-4257
(262) 787-4050
(262) 439-7683
Taxonomy
Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
PENDING
WI
Other
Enumeration date
08/12/2019
Last updated
08/12/2019
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