Organization
LAKESIDE FAMILY PRACTICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANTHONY HALE DNP, FNP-BC (OWNER)
(262) 225-1014
Entity
Organization
Contact information
Practice address
3200 SHERIDAN RD STE 104, KENOSHA, WI 53140-1921
(262) 225-1014
Mailing address
2113 TALLGRASS CIR, WAUKESHA, WI 53188-2606
(262) 225-1014
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2011006054
WI
363LG0600X
Gerontology Nurse Practitioner
6190-33
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100018824
—
WI
05
—
100043522
—
WI
Enumeration date
02/08/2018
Last updated
02/08/2018
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