NPI 1154635860

Kristin M Lavenhagen, PAC

Practitioner Physician Assistant Oak Creek, WI

Practice location

Address: 331 E Puetz Rd Lakeshore Medical Clinic, Oak Creek, WI 53154-3253
Phone: (414) 570-3590
Mailing address: 100 15th Avenue Lakeshore Medical Clinic, South Milwaukee, WI 53172-1160

Registered specialties

Physician Assistant Primary

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 363A00000X Licence 2636-23 (WI)

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Registry record

NPI: 1154635860
Entity type: Individual
Sex (as registered): Female
NPI issued: 5 Aug 2010
Record last updated: 28 Sep 2012

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.