Provider Demographics
NPI:1659542306
Name:RHEA, LISA ANN (RN)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:ANN
Last Name:RHEA
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 1:3505 BELKNAP ST TRLR 46
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:WI
Mailing Address - Zip Code:54880-2169
Mailing Address - Country:US
Mailing Address - Phone:218-428-6683
Mailing Address - Fax:
Practice Address - Street 1:3505 BELKNAP ST TRLR 46
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880-2169
Practice Address - Country:US
Practice Address - Phone:218-428-6683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1379688163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse