Provider Demographics
NPI:1700308558
Name:BOURQUIN, LISA ANN (FNP-APNP)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ANN
Last Name:BOURQUIN
Suffix:
Gender:F
Credentials:FNP-APNP
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:ANN
Other - Last Name:BYRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:800 CLAY ST
Mailing Address - Street 2:
Mailing Address - City:DARLINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53530-1228
Mailing Address - Country:US
Mailing Address - Phone:608-776-3614
Mailing Address - Fax:608-776-2317
Practice Address - Street 1:1 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:GALENA
Practice Address - State:IL
Practice Address - Zip Code:61036-8118
Practice Address - Country:US
Practice Address - Phone:815-777-1340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-13
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI77653-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily