MEDICARE: LOLA'S NEW BEGINNINGS

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	163WC0400X	Case Management Registered Nurse

General Provider Information

NPI Number	:	1205467172
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOLA'S NEW BEGINNINGS

Provider Business Mailing Address
First Line	:	2913 S 14TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53215-3841
Country	:	US
Telephone Number	:	414-334-8934
Fax Number	:

Provider Business Practice Location Address
First Line	:	3632 S 77TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53220-1146
Country	:	US
Telephone Number	:	414-334-8934
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	STEPHANIE SOTO
Credential	:
Telephone Number	:	414-334-8934

Provider Enumeration Date	:	01/30/2020
Last Update Date	:	01/30/2020

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Directions to “LOLA'S NEW BEGINNINGS ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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