Provider Demographics
NPI:1710387972
Name:HANEY, LISA M (APNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:HANEY
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:MAAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APNP
Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:CRITICAL CARE MEDICINE
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-955-7040
Mailing Address - Fax:414-955-6211
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:CRITICAL CARE MEDICINE
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-955-7040
Practice Address - Fax:414-955-6211
Is Sole Proprietor?:No
Enumeration Date:2014-08-25
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5976-33363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1710387972Medicaid