Provider Demographics
NPI:1407323595
Name:BEEN, LAKEN NICHOLE
Entity Type:Individual
Prefix:
First Name:LAKEN
Middle Name:NICHOLE
Last Name:BEEN
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 1:4670 WOODFIELD CT APT 3
Mailing Address - Street 2:
Mailing Address - City:NASHOTAH
Mailing Address - State:WI
Mailing Address - Zip Code:53058-9309
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4670 WOODFIELD CT APT 3
Practice Address - Street 2:
Practice Address - City:NASHOTAH
Practice Address - State:WI
Practice Address - Zip Code:53058-9309
Practice Address - Country:US
Practice Address - Phone:803-543-3510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-27
Last Update Date:2018-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Multi-Specialty