Individual
LAWANNA RIVERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4647 W FOND DU LAC AVE, MILWAUKEE, WI 53216-2422
(901) 825-7991
Mailing address
4647 W FOND DU LAC AVE, MILWAUKEE, WI 53216-2422
(901) 825-7991
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
310652-031
WI
Other
Enumeration date
09/16/2009
Last updated
09/16/2009
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