MEDICARE: MRS. LAWON A SMITH DONA CD

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	374J00000X	Doula	15383	IL

General Provider Information

NPI Number	:	1124868179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAWON A SMITH DONA CD

Provider Business Mailing Address
First Line	:	1420 N 39TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53208-2330
Country	:	US
Telephone Number	:	773-754-9554
Fax Number	:

Provider Business Practice Location Address
First Line	:	6111 N TEUTONIA AVE STE 135
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53209-3646
Country	:	US
Telephone Number	:	773-754-9554
Fax Number	:

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

Provider Enumeration Date	:	05/28/2024
Last Update Date	:	05/28/2024

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