Provider Demographics
NPI:1942251798
Name:GRABER, LISA A (NP)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:A
Last Name:GRABER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:GENERAL SURGERY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-5806
Mailing Address - Fax:414-805-5934
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:GENERAL SURGERY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-5806
Practice Address - Fax:414-805-5934
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI119115363L00000X
WI2414363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
002806261EOtherHUMANA
WI1942251798Medicaid
WI1942251798Medicaid
WI078A 73-601Medicare PIN