Lawana G.Bryant Al-Dhari, R.N.
Individual provider Active NPI Registered Nurse · Bayview, WI
NPI 1477594315 · NPPES record last updated Aug 14, 2007
Key facts
- NPI
- 1477594315
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- 77548-030 (WI)
- Practice address
- 2151 S Mound St
Bayview, WI 53207-1331 - Phone
- (414) 630-0503
- NPI assigned
- Jun 10, 2006
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 77548-030 | WI | MD | Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 77548-030 | WI | Yes |
Addresses
Primary practice location
2151 S Mound St
Bayview, WI 53207-1331
Mailing address
PO Box 14113
West Allis, WI 53214-0113
Phone (414) 630-0503
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 39805000 | Medicaid | WI |
Other providers in Bayview, WI
All providers in Bayview, WI · Registered Nurse in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 14, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.