Individual
JAN LUCAS NOSSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2345 N 114TH ST, WAUWATOSA, WI 53226-1225
(414) 453-0135
Mailing address
2345 N 114TH ST, WAUWATOSA, WI 53226-1225
(414) 453-0135
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1270
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40092200
—
WI
Enumeration date
11/26/2006
Last updated
07/09/2007
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