=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881566776
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAFLORENCE MERRILLE COLLINS CNA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2025
-----------------------------------------------------
Last Update Date | 09/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9011 N 86TH ST
-----------------------------------------------------
City | MILWAUKEE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53224-1805
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-993-9556
-----------------------------------------------------
Fax | 775-640-6832
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 333 W BROWN DEER RD UNIT G-603
-----------------------------------------------------
City | BAYSIDE
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53217-2372
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 262-993-9556
-----------------------------------------------------
Fax | 775-640-6832
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 376K00000X
-----------------------------------------------------
Taxonomy Name | Nurse's Aide
-----------------------------------------------------
License Number | 148760
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------