Provider Demographics
NPI:1467425082
Name:THINNES, LISA L (PA-C)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:L
Last Name:THINNES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PROHEALTH CARE MEDICAL ASSOCIATES INC.
Mailing Address - Street 2:N17 W24100 RIVERWOOD DRIVE SUITE 250
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-1177
Mailing Address - Country:US
Mailing Address - Phone:262-928-4100
Mailing Address - Fax:262-928-5835
Practice Address - Street 1:PROHEALTH CARE MEDICAL ASSOCIATES INC.
Practice Address - Street 2:2130 BIG BEND RD
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53189-7624
Practice Address - Country:US
Practice Address - Phone:262-928-7555
Practice Address - Fax:262-513-7575
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1016363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42977300Medicaid
683750701Medicare PIN
WIS80212Medicare UPIN