Provider Demographics
NPI:1043548365
Name:SPANNBAUER, LISA M (APNP)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:M
Last Name:SPANNBAUER
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1787
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53008
Mailing Address - Country:US
Mailing Address - Phone:262-827-9200
Mailing Address - Fax:262-827-8641
Practice Address - Street 1:2085 N CALHOUN ROAD
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005
Practice Address - Country:US
Practice Address - Phone:262-827-9200
Practice Address - Fax:262-827-8641
Is Sole Proprietor?:No
Enumeration Date:2009-11-24
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4083-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL041.380918OtherRN LICENSE
IL209.007912OtherAPNP LICENSE
WI4083-33OtherAPNP LICENSE
WI149451-30OtherRN LICENSE