Provider Demographics
NPI:1942752506
Name:LISKO, HEATHER L (APRNP)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:L
Last Name:LISKO
Suffix:
Gender:F
Credentials:APRNP
Other - Prefix:MS
Other - First Name:HEATHER
Other - Middle Name:L
Other - Last Name:MARSCHALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRNP
Mailing Address - Street 1:9000 W WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4874
Mailing Address - Country:US
Mailing Address - Phone:414-266-2090
Mailing Address - Fax:414-266-3157
Practice Address - Street 1:9000 W WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4874
Practice Address - Country:US
Practice Address - Phone:414-266-2090
Practice Address - Fax:414-266-3157
Is Sole Proprietor?:No
Enumeration Date:2016-10-31
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI179349363LP0200X
WI7397363LP0200X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1942752506Medicaid