Provider Demographics
NPI:1235135559
Name:LASSANSKE, ERIN C (NP)
Entity type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:C
Last Name:LASSANSKE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 W KK RIVER PKWY
Mailing Address - Street 2:STE 305
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-3660
Mailing Address - Country:US
Mailing Address - Phone:414-645-6070
Mailing Address - Fax:414-645-6354
Practice Address - Street 1:2901 W KK RIVER PKWY
Practice Address - Street 2:STE 305
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-3660
Practice Address - Country:US
Practice Address - Phone:414-645-6070
Practice Address - Fax:414-645-6354
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2564-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41195700Medicaid
WIQ23467Medicare UPIN
WI01845Medicare ID - Type UnspecifiedMEDICARE NUMBER