Provider Demographics
NPI:1942474952
Name:MAYER, LISA BETH (RN)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:BETH
Last Name:MAYER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 CHEYENNE AVE UNIT C
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:WI
Mailing Address - Zip Code:53024-1645
Mailing Address - Country:US
Mailing Address - Phone:262-387-1377
Mailing Address - Fax:
Practice Address - Street 1:803 CHEYENNE AVE UNIT C
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:WI
Practice Address - Zip Code:53024-1645
Practice Address - Country:US
Practice Address - Phone:262-387-1377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI111049-030163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse