Provider Demographics
NPI:1730643560
Name:BRUZEK, LISA
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:BRUZEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5518 OAKES AVE
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:WI
Mailing Address - Zip Code:54880-5763
Mailing Address - Country:US
Mailing Address - Phone:218-349-2205
Mailing Address - Fax:
Practice Address - Street 1:4961 RICE LAKE RD STE 105
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55803-8439
Practice Address - Country:US
Practice Address - Phone:218-727-4105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-25
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN226069-9163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management