Provider Demographics
NPI:1225452345
Name:LEVER, PHYLLIS
Entity Type:Individual
Prefix:MS
First Name:PHYLLIS
Middle Name:
Last Name:LEVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 72068
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53212-7268
Mailing Address - Country:US
Mailing Address - Phone:414-467-0303
Mailing Address - Fax:
Practice Address - Street 1:2807 N 20TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53206-1605
Practice Address - Country:US
Practice Address - Phone:414-467-0303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-10
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIL1606617891608172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver