Lavenhagen, Kristin M
Lavenhagen, Kristin M is an individual health care provider with primary practice located at 331 E Puetz Rd Lakeshore Medical Clinic, Oak Creek WI 53154-3253. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Lavenhagen, Kristin M can be contacted via phone (414) 570-3590.Contact Information
Primary practice address
331 E Puetz Rd Lakeshore Medical Clinic
Oak Creek WI 53154-3253
Phone: (414) 570-3590
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant | 363A00000X | 2636-23 | Wisconsin |
Profile Details
| NPI number | 1154635860 |
|---|---|
| LBN Legal business name | Lavenhagen, Kristin M |
| Credentials | Physician's Assistant Certified (PA-C) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Aug 5th, 2010 |
| Last updated | Sep 28th, 2012 - about 13 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1154635860 | NPPES |
| Wisconsin | Other | 2636-23 | WISCONSIN LICENSE |
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