Provider Demographics
NPI:1003587346
Name:LAKELAND CLINIC LLC
Entity Type:Organization
Organization Name:LAKELAND CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAIGE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:HARPER
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:319-573-9723
Mailing Address - Street 1:610 WEST AVE STE C
Mailing Address - Street 2:
Mailing Address - City:RICE LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54868-1387
Mailing Address - Country:US
Mailing Address - Phone:715-202-6727
Mailing Address - Fax:
Practice Address - Street 1:610 WEST AVE STE C
Practice Address - Street 2:
Practice Address - City:RICE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54868-1387
Practice Address - Country:US
Practice Address - Phone:715-202-6727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-27
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center