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Individual

TYRA B LEA

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
7323 N 86TH ST, MILWAUKEE, WI 53224-4115
(414) 326-7312
Mailing address
PO BOX 250554, MILWAUKEE, WI 53225-6507
(414) 326-7312

Taxonomy

Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
308747031
WI

Other

Enumeration date
11/09/2010
Last updated
11/09/2010
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