Individual
KELLY LAWSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10625 W NORTH AVE STE 101B, WAUWATOSA, WI 53226-2315
(414) 727-9183
Mailing address
10625 W NORTH AVE STE 101B, WAUWATOSA, WI 53226-2315
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
7037-23
WI
Other
Enumeration date
03/08/2022
Last updated
03/14/2023
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