Healthcare Provider Details

I. General information

NPI: 1205467172
Provider Name (Legal Business Name): LOLA'S NEW BEGINNINGS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2020
Last Update Date: 01/30/2020
Certification Date: 01/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3632 S 77TH ST
MILWAUKEE WI
53220-1146
US

IV. Provider business mailing address

2913 S 14TH ST
MILWAUKEE WI
53215-3841
US

V. Phone/Fax

Practice location:
  • Phone: 414-334-8934
  • Fax:
Mailing address:
  • Phone: 414-334-8934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE SOTO
Title or Position: OWNER
Credential:
Phone: 414-334-8934