Provider Demographics
NPI:1396338604
Name:LACHOWIN, REBECCA A
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:A
Last Name:LACHOWIN
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:N41W22720 SUNDER CREEK DR
Mailing Address - Street 2:
Mailing Address - City:PEWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53072-2267
Mailing Address - Country:US
Mailing Address - Phone:414-534-2621
Mailing Address - Fax:
Practice Address - Street 1:1000 NORTHVIEW RD
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-1617
Practice Address - Country:US
Practice Address - Phone:414-534-2621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-17
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI149800163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse