Healthcare Provider Details

I. General information

NPI: 1255952149
Provider Name (Legal Business Name): CLARISSA MARIE LAWRENCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2020
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7929 N 76TH ST
MILWAUKEE WI
53223-3947
US

IV. Provider business mailing address

7929 N 76TH ST
MILWAUKEE WI
53223-3947
US

V. Phone/Fax

Practice location:
  • Phone: 414-554-9774
  • Fax: 414-979-0325
Mailing address:
  • Phone: 414-554-9774
  • Fax: 414-979-0325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. CLARISSA M LAWRENCE
Title or Position: OWNER/FAMILY NURSE PRACTITIONER
Credential: DNP, APNP, FNP-BC
Phone: 414-554-9774