Provider Demographics
NPI:1821378647
Name:LOCKETT-NEUMUTH, LISA D (WHNP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:D
Last Name:LOCKETT-NEUMUTH
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:D
Other - Last Name:LOCKETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-6600
Mailing Address - Fax:414-805-6622
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-6600
Practice Address - Fax:414-805-6622
Is Sole Proprietor?:No
Enumeration Date:2011-08-24
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4512367A00000X
WI4512-033363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100018560Medicaid
WI1821378647Medicaid