MEDICARE: LATRICE LEWIS LPN

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	311148031	WI

General Provider Information

NPI Number	:	1255771572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LATRICE LEWIS LPN

Provider Business Mailing Address
First Line	:	2954 N 21ST ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53206-1631
Country	:	US
Telephone Number	:	414-915-0873
Fax Number	:

Provider Business Practice Location Address
First Line	:	2954 N 21ST ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53206-1631
Country	:	US
Telephone Number	:	414-915-0873
Fax Number	:

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

Provider Enumeration Date	:	07/01/2013
Last Update Date	:	10/09/2015

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