Individual
ELIZABETH LANUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10400 75TH ST, KENOSHA, WI 53142-7884
(262) 948-5600
Mailing address
10400 75TH ST, KENOSHA, WI 53142-7884
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
18080
WI
363L00000X
Nurse Practitioner
Primary
18080
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1760338107
—
WI
Enumeration date
03/09/2026
Last updated
06/12/2026
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