Healthcare Provider Details

I. General information

NPI: 1750616322
Provider Name (Legal Business Name): MS. ERIN REBECCA LANCE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2009
Last Update Date: 10/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 E BELLEVIEW PL 210
MILWAUKEE WI
53211-4061
US

IV. Provider business mailing address

2222 E BELLEVIEW PL 210
MILWAUKEE WI
53211-4061
US

V. Phone/Fax

Practice location:
  • Phone: 414-803-0338
  • Fax:
Mailing address:
  • Phone: 414-803-0338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: