Provider Demographics
NPI:1518532423
Name:FREY, LELA M (RN)
Entity Type:Individual
Prefix:
First Name:LELA
Middle Name:M
Last Name:FREY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LELA
Other - Middle Name:M
Other - Last Name:WITHROW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2240 PRAIRIE AVE
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-2648
Mailing Address - Country:US
Mailing Address - Phone:608-361-7200
Mailing Address - Fax:
Practice Address - Street 1:2240 PRAIRIE AVE
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511-2648
Practice Address - Country:US
Practice Address - Phone:608-361-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-24
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI178761163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse