Individual
MS. LAKISHA REFAY CLEMONS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
4037 N 84TH ST, MILWAUKEE, WI 53222-1811
(414) 461-0418
Mailing address
4037 N 84TH ST, MILWAUKEE, WI 53222-1811
(414) 461-0418
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
38318700
PROVIDER NUMBER
WI
Enumeration date
04/05/2008
Last updated
04/05/2008
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