Individual
JILL JANINE LAU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
19333 W NORTH AVE, BROOKFIELD, WI 53045-4132
(262) 785-2000
Mailing address
2031 N 49TH ST, MILWAUKEE, WI 53208-1737
(414) 759-6242
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
196260-30
WI
367500000X
Certified Registered Nurse Anesthetist
Primary
12004
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00000
N/A
WI
Enumeration date
09/30/2021
Last updated
08/19/2022
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