Lakeside Family Practice

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

2011006054 Issued in WI

Legal business name

LAKESIDE FAMILY PRACTICE

Practice address

3200 Sheridan Rd Ste 104
Kenosha, WI 53140-1921

Phone

(262) 225-1014

NPI assigned

Feb 8, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Anthony Hale, DNP, FNP-BC

Title

Owner

Phone

(262) 225-1014

Specialties & licenses 2

Addresses

Other identifiers 2

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1518048000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1518048000000",
    "number": "1831698430",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2113 TALLGRASS CIR",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531882606",
            "telephone_number": "262-225-1014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 SHERIDAN RD STE 104",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531401921",
            "telephone_number": "262-225-1014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESIDE FAMILY PRACTICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-08",
        "last_updated": "2018-02-08",
        "status": "A",
        "authorized_official_last_name": "HALE",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "262-225-1014",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DNP, FNP-BC"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "WI",
            "license": "2011006054",
            "primary": true
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "WI",
            "license": "6190-33",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100043522",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100018824",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alexandre Lacrosse
• Anne R Lakayil, DDS
• Lakeshore Pain and Spine Center LLC
• Lakeshores Outpatient Clinic (Brotoloc)
• Lakeside Chiropractic LLC
• Jevan Christopher Lalgee, HIS
• Pamela A. Lamacchia, CSAC
• Kristine Marie Lamothe, LPN
• Jessica Lancaster, MD
• Bonnie M Lancour, COTA

• Family Nurse Practitioner in Kenosha, WI
• Providers in Kenosha, WI by specialty
• Family Nurse Practitioner in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.