Provider Demographics
NPI:1740716224
Name:HARTJES, LISA (RN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:HARTJES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 CHERRY LN
Mailing Address - Street 2:
Mailing Address - City:LITTLE CHUTE
Mailing Address - State:WI
Mailing Address - Zip Code:54140-1107
Mailing Address - Country:US
Mailing Address - Phone:920-716-1279
Mailing Address - Fax:
Practice Address - Street 1:332 CHERRY LN
Practice Address - Street 2:
Practice Address - City:LITTLE CHUTE
Practice Address - State:WI
Practice Address - Zip Code:54140-1107
Practice Address - Country:US
Practice Address - Phone:920-781-6127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-03
Last Update Date:2017-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI90122163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice