Provider Demographics
NPI:1174980098
Name:OBRIEN, LISA (APNP)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:OBRIEN
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3111 W RAWSON AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-9417
Mailing Address - Country:US
Mailing Address - Phone:414-325-4370
Mailing Address - Fax:414-761-0713
Practice Address - Street 1:3111 W RAWSON AVE STE 210
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132
Practice Address - Country:US
Practice Address - Phone:414-325-4370
Practice Address - Fax:414-325-4370
Is Sole Proprietor?:No
Enumeration Date:2016-01-22
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI161903-30163W00000X
WI6787-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse