Provider Demographics
NPI:1104479955
Name:DORWIN, LANITA
Entity type:Individual
Prefix:
First Name:LANITA
Middle Name:
Last Name:DORWIN
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:W4794 COUNTY ROAD B
Mailing Address - Street 2:
Mailing Address - City:DURAND
Mailing Address - State:WI
Mailing Address - Zip Code:54736-4614
Mailing Address - Country:US
Mailing Address - Phone:715-672-5679
Mailing Address - Fax:715-672-5669
Practice Address - Street 1:W4794 COUNTY ROAD B
Practice Address - Street 2:
Practice Address - City:DURAND
Practice Address - State:WI
Practice Address - Zip Code:54736-4614
Practice Address - Country:US
Practice Address - Phone:715-672-5679
Practice Address - Fax:715-672-5669
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1001999171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications