Provider Demographics
NPI:1396150843
Name:GREGAR, LISA RUTH (RN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:RUTH
Last Name:GREGAR
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:RUTH
Other - Last Name:BURTICK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:JUNEAU COUNTY DEPT OF HUMAN SERVICES
Mailing Address - Street 2:200 HICKORY ST
Mailing Address - City:MAUSTON
Mailing Address - State:WI
Mailing Address - Zip Code:53948
Mailing Address - Country:US
Mailing Address - Phone:608-847-2400
Mailing Address - Fax:608-847-9421
Practice Address - Street 1:JUNEAU COUNTY DEPT OF HUMAN SERVICES
Practice Address - Street 2:200 HICKORY ST
Practice Address - City:MAUSTON
Practice Address - State:WI
Practice Address - Zip Code:53948
Practice Address - Country:US
Practice Address - Phone:608-847-2400
Practice Address - Fax:608-847-9421
Is Sole Proprietor?:No
Enumeration Date:2014-06-24
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI146956-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse