Healthcare Provider Details

I. General information

NPI: 1235646456
Provider Name (Legal Business Name): KATHERINE LAZZARA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2018
Last Update Date: 01/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6220 WASHINGTON AVE STE D
MOUNT PLEASANT WI
53406-3952
US

IV. Provider business mailing address

6220 WASHINGTON AVE STE D
MOUNT PLEASANT WI
53406-3952
US

V. Phone/Fax

Practice location:
  • Phone: 262-884-0600
  • Fax:
Mailing address:
  • Phone: 262-884-0600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number1540-60
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: