Individual
MS. JEAN A LAUTERBACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2239 S 108TH ST, WEST ALLIS, WI 53227-1107
(414) 541-2772
(414) 541-2728
Mailing address
2239 S 108TH ST, WEST ALLIS, WI 53227-1107
(414) 541-2772
(414) 541-2728
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
186-023
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42931100
—
WI
Enumeration date
08/23/2006
Last updated
07/26/2013
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