Individual
MARY LARA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
9338 S 48TH ST, FRANKLIN, WI 53132-7613
(414) 617-0710
Mailing address
9338 S 48TH ST, FRANKLIN, WI 53132-7613
(414) 617-0710
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
38202800
—
WI
Enumeration date
04/16/2008
Last updated
04/16/2008
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