Provider Demographics
NPI:1164963187
Name:LANMAN, ANNA (LMT)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:LANMAN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:BARABOO
Mailing Address - State:WI
Mailing Address - Zip Code:53913-1612
Mailing Address - Country:US
Mailing Address - Phone:608-434-6807
Mailing Address - Fax:
Practice Address - Street 1:303 12TH AVE
Practice Address - Street 2:
Practice Address - City:BARABOO
Practice Address - State:WI
Practice Address - Zip Code:53913-1612
Practice Address - Country:US
Practice Address - Phone:608-434-6807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60683197405300000X
WI13109-146405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes405300000XOther Service ProvidersPrevention Professional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI2404126121Medicare NSC