Provider Demographics
NPI:1508604505
Name:BRISKIE, LIZA
Entity type:Individual
Prefix:
First Name:LIZA
Middle Name:
Last Name:BRISKIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N3694 COUNTY ROAD SS
Mailing Address - Street 2:
Mailing Address - City:PINE RIVER
Mailing Address - State:WI
Mailing Address - Zip Code:54965-7417
Mailing Address - Country:US
Mailing Address - Phone:920-420-2771
Mailing Address - Fax:
Practice Address - Street 1:N3694 COUNTY ROAD SS
Practice Address - Street 2:
Practice Address - City:PINE RIVER
Practice Address - State:WI
Practice Address - Zip Code:54965-7417
Practice Address - Country:US
Practice Address - Phone:920-420-2771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-16
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care