Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 10902-33 | WI |
NPI | 1003580044 |
---|---|
Provider Name | Lindsey Marie Mena |
First Address | South Milwaukee, WI 53172-1019 |
Second Address | South Milwaukee, WI 53172-3708 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2021 |
Last Update Date | 03/08/2021 |