MEDICARE: LAZRIA PRICE

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	251S00000X	Community/Behavioral Health Agency	16859	WI

General Provider Information

NPI Number	:	1700229564
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAZRIA PRICE

Provider Business Mailing Address
First Line	:	4001 W CAPITOL DR
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-2530
Country	:	US
Telephone Number	:	414-759-6377
Fax Number	:

Provider Business Practice Location Address
First Line	:	4001 W CAPITOL DR
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-2530
Country	:	US
Telephone Number	:	414-455-3879
Fax Number	:

Authorized Official
Title or Position	:	SAC-IT
Name	:	LAZRIA TRINETTE PRICE
Credential	:
Telephone Number	:	262-497-3445

Provider Enumeration Date	:	04/11/2013
Last Update Date	:	04/12/2013

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Directions to “LAZRIA PRICE ” Practice Location

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