Provider Demographics
NPI:1548223142
Name:BRISLEY, ANITA ANN (RN)
Entity Type:Individual
Prefix:MS
First Name:ANITA
Middle Name:ANN
Last Name:BRISLEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 1ST ST
Mailing Address - Street 2:
Mailing Address - City:BELGIUM
Mailing Address - State:WI
Mailing Address - Zip Code:53004-9313
Mailing Address - Country:US
Mailing Address - Phone:414-380-9725
Mailing Address - Fax:
Practice Address - Street 1:141 1ST ST
Practice Address - Street 2:
Practice Address - City:BELGIUM
Practice Address - State:WI
Practice Address - Zip Code:53004-9313
Practice Address - Country:US
Practice Address - Phone:414-380-9725
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39932800Medicaid