Liedke, Lisa Jo

Liedke, Lisa Jo is an individual health care provider with primary practice located at 210 Wisconsin American Dr , Fond Du Lac WI 54937-2999. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Occupational Health, Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner. Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner is her primary health care specialty. Liedke, Lisa Jo can be contacted via phone (920) 907-7000.

Contact Information

Primary practice address
210 Wisconsin American Dr Fond Du Lac WI 54937-2999
Phone: (920) 907-7000
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Occupational Health 363LX0106X 9728 Wisconsin
Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner 363L00000X 9728 Wisconsin

Profile Details

NPI number 1336783042
LBN Legal business name Liedke, Lisa Jo
Credentials APNP
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 5th, 2019
Last updated Oct 7th, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1336783042 NPPES
Wisconsin MEDICAID 100095421

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