Provider Demographics
NPI:1972664340
Name:ANDERSON, RISA A (APNP)
Entity Type:Individual
Prefix:
First Name:RISA
Middle Name:A
Last Name:ANDERSON
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 1:9875 S FRANKLIN DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132-8895
Mailing Address - Country:US
Mailing Address - Phone:414-649-1292
Mailing Address - Fax:414-858-2236
Practice Address - Street 1:2900 W OKLAHOMA AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-4330
Practice Address - Country:US
Practice Address - Phone:414-649-1292
Practice Address - Fax:414-385-8721
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1517363L00000X
WI125006-030163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WW0000XNursing Service ProvidersRegistered NurseWound Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100003796Medicaid