Provider Demographics
NPI:1689000911
Name:WANG, LISA A (APRN, FNP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:WANG
Suffix:
Gender:F
Credentials:APRN, FNP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:A
Other - Last Name:KAMM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1038 E GENEVA ST
Mailing Address - Street 2:
Mailing Address - City:DELAVAN
Mailing Address - State:WI
Mailing Address - Zip Code:53115-1921
Mailing Address - Country:US
Mailing Address - Phone:262-728-4301
Mailing Address - Fax:262-728-8304
Practice Address - Street 1:1038 E GENEVA ST
Practice Address - Street 2:
Practice Address - City:DELAVAN
Practice Address - State:WI
Practice Address - Zip Code:53115-1921
Practice Address - Country:US
Practice Address - Phone:262-728-4301
Practice Address - Fax:262-728-8304
Is Sole Proprietor?:No
Enumeration Date:2013-09-18
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5379-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily