Provider Demographics
NPI:1679746655
Name:FOLEY, LISA ROCHELLE (RDH)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ROCHELLE
Last Name:FOLEY
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MISS
Other - First Name:LISA
Other - Middle Name:ROCHELLE
Other - Last Name:BANSEMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:PO BOX 80257
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53208-8004
Mailing Address - Country:US
Mailing Address - Phone:414-935-8000
Mailing Address - Fax:414-935-8011
Practice Address - Street 1:3522 W LISBON AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53208
Practice Address - Country:US
Practice Address - Phone:414-935-8000
Practice Address - Fax:414-935-8011
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5796-16124Q00000X
WI5796124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33810800Medicaid