Organization
BLUE LOTUS LIFE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MISS SHANTELL RILEY REGISTERED NURSE (OWNER)
(414) 522-5924
Entity
Organization
Contact information
Practice address
3808 N 60TH ST, MILWAUKEE, WI 53216-2133
(414) 999-1117
Mailing address
3808 N 60TH ST, MILWAUKEE, WI 53216-2133
(414) 522-5924
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Enumeration date
04/05/2023
Last updated
04/05/2023
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