Healthcare Provider Details

I. General information

NPI: 1275750648
Provider Name (Legal Business Name): JUDITH ANN LEMBRICH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 W MAIN ST
WHITEWATER WI
53190-1705
US

IV. Provider business mailing address

544 E OGDEN ST
JEFFERSON WI
53549-1351
US

V. Phone/Fax

Practice location:
  • Phone: 262-472-1300
  • Fax:
Mailing address:
  • Phone: 920-674-5122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1400X
TaxonomyCollege Health Registered Nurse
License Number47203030
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: