Organization
LAKE VIEW ADULT FAMILY HOME
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DOUANGMALA PHRASAVATH RN (REGISTERED NURSE)
(414) 379-9713
Entity
Organization
Contact information
Practice address
W278N2456 PROSPECT AVE, PEWAUKEE, WI 53072-5220
(414) 379-9713
Mailing address
W278N2456 PROSPECT AVE, PEWAUKEE, WI 53072-5220
(414) 379-9713
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
08/19/2009
Last updated
08/19/2009
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