Provider Demographics
NPI:1073370870
Name:DIDIER, LISA CHRISTINE (MSES)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:CHRISTINE
Last Name:DIDIER
Suffix:
Gender:F
Credentials:MSES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 WISCONSIN AVE STE 146
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:WI
Mailing Address - Zip Code:53024-1995
Mailing Address - Country:US
Mailing Address - Phone:414-367-9411
Mailing Address - Fax:
Practice Address - Street 1:1525 WISCONSIN AVE STE 146
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:WI
Practice Address - Zip Code:53024-1995
Practice Address - Country:US
Practice Address - Phone:414-367-9411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist