Healthcare Provider Details

I. General information

NPI: 1477804466
Provider Name (Legal Business Name): LAKEESHA SHONTELL ROBINSON FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2012
Last Update Date: 01/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3853 N 54TH BLVD
MILWAUKEE WI
53216-2205
US

IV. Provider business mailing address

3853 N. 54TH BLVD
MILWAUKEE WI
53216
US

V. Phone/Fax

Practice location:
  • Phone: 414-841-0104
  • Fax:
Mailing address:
  • Phone: 414-841-0104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5072-33
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number5072-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: