Individual
MISS LATEISHA PRESCOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APNP
Contact information
Practice address
34700 VALLEY RD, OCONOMOWOC, WI 53066-4599
(262) 646-4411
Mailing address
4600 W SCHROEDER DR, BROWN DEER, WI 53223-6458
(414) 865-2500
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
176126-30
WI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
10005-33
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1609410364
—
WI
Enumeration date
11/05/2019
Last updated
07/10/2020
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