MEDICARE: LANCHA FRIERSON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	314921-31	WI

General Provider Information

NPI Number	:	1083960231
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LANCHA FRIERSON

Provider Business Mailing Address
First Line	:	3435 N 83RD ST # DT
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53222-3864
Country	:	US
Telephone Number	:	702-205-0134
Fax Number	:

Provider Business Practice Location Address
First Line	:	3435 N 83RD ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53222-3864
Country	:	US
Telephone Number	:	702-205-0134
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2012
Last Update Date	:	07/25/2012

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Directions to “ LANCHA FRIERSON ” Practice Location

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