Individual
LAKESHA BANNISTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5802 N 80TH ST, MILWAUKEE, WI 53218-1717
(414) 722-3258
Mailing address
5802 N 80TH ST, MILWAUKEE, WI 53218-1717
(414) 722-3258
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
0017488
WI
Other
Enumeration date
06/05/2019
Last updated
06/05/2019
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