Individual
LISA M TAYLOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
N5274 LEMKE RD, CHILTON, WI 53014-9339
(920) 418-5574
Mailing address
N5274 LEMKE RD, CHILTON, WI 53014-9339
(920) 418-5574
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
307349-031
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
35011500
—
WI
Enumeration date
12/11/2009
Last updated
12/11/2009
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