Provider Demographics
NPI:1700066685
Name:FRISQUE, LISA M (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:M
Last Name:FRISQUE
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MISS
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:FRISQUE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:1910 ALABAMA ST
Mailing Address - Street 2:
Mailing Address - City:STURGEON BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54235-3532
Mailing Address - Country:US
Mailing Address - Phone:920-746-7200
Mailing Address - Fax:
Practice Address - Street 1:1910 ALABAMA ST
Practice Address - Street 2:
Practice Address - City:STURGEON BAY
Practice Address - State:WI
Practice Address - Zip Code:54235-3532
Practice Address - Country:US
Practice Address - Phone:920-746-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-08
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI405933363L00000X, 363L00000X
WI147386030163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38321300Medicaid