Provider Demographics
NPI:1083267413
Name:MEDROW, LUCILLE (RN)
Entity Type:Individual
Prefix:
First Name:LUCILLE
Middle Name:
Last Name:MEDROW
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LUCILLE
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1255 EDWARDS ST
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-7154
Mailing Address - Country:US
Mailing Address - Phone:262-206-7901
Mailing Address - Fax:
Practice Address - Street 1:1255 EDWARDS ST
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-7154
Practice Address - Country:US
Practice Address - Phone:262-206-7901
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-24
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI189529163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse