Provider Demographics
NPI:1881865012
Name:LISA SALAWAY
Entity Type:Organization
Organization Name:LISA SALAWAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:R.N.
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:SALAWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-845-2243
Mailing Address - Street 1:510 CABRILLO CT
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:WI
Mailing Address - Zip Code:53593-8233
Mailing Address - Country:US
Mailing Address - Phone:608-845-2243
Mailing Address - Fax:
Practice Address - Street 1:510 CABRILLO CT
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:WI
Practice Address - Zip Code:53593-8233
Practice Address - Country:US
Practice Address - Phone:608-845-2243
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-16
Last Update Date:2008-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI996590303140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric