Provider Demographics
NPI:1477195345
Name:CROUSE, LISA ANN (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:CROUSE
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 W RICHLAND ST
Mailing Address - Street 2:
Mailing Address - City:LONE ROCK
Mailing Address - State:WI
Mailing Address - Zip Code:53556-3912
Mailing Address - Country:US
Mailing Address - Phone:608-604-2230
Mailing Address - Fax:
Practice Address - Street 1:404 W RICHLAND ST
Practice Address - Street 2:
Practice Address - City:LONE ROCK
Practice Address - State:WI
Practice Address - Zip Code:53556-3912
Practice Address - Country:US
Practice Address - Phone:608-604-2230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-12
Last Update Date:2019-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI152126-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse