MEDICARE: LAKEESHA SHONTELL ROBINSON FNP-BC

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	363LF0000X	Family Nurse Practitioner	5072-33	WI
2	363LP2300X	Primary Care Nurse Practitioner	5072-33	WI

General Provider Information

NPI Number	:	1477804466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAKEESHA SHONTELL ROBINSON FNP-BC

Provider Business Mailing Address
First Line	:	3853 N. 54TH BLVD
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216
Country	:	US
Telephone Number	:	414-841-0104
Fax Number	:

Provider Business Practice Location Address
First Line	:	3853 N 54TH BLVD
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-2205
Country	:	US
Telephone Number	:	414-841-0104
Fax Number	:

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

Provider Enumeration Date	:	10/01/2012
Last Update Date	:	01/04/2016

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