Provider Demographics
NPI:1922059773
Name:LIESCH, SHARI K (APNP)
Entity Type:Individual
Prefix:MS
First Name:SHARI
Middle Name:K
Last Name:LIESCH
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2575 E EVERGREEN DRIVE
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-8904
Mailing Address - Country:US
Mailing Address - Phone:920-969-5353
Mailing Address - Fax:414-337-7201
Practice Address - Street 1:2575 E EVERGREEN DRIVE
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913-8904
Practice Address - Country:US
Practice Address - Phone:920-969-5353
Practice Address - Fax:414-337-7201
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2684363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1922059773Medicaid
WI41278900Medicaid
WI003507520Medicare PIN
WI41278900Medicaid