Provider Demographics
NPI:1831225374
Name:GARTMANN, LISA ANNE (LPN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ANNE
Last Name:GARTMANN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 COUNTY ROAD D
Mailing Address - Street 2:
Mailing Address - City:WOODVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54028-7116
Mailing Address - Country:US
Mailing Address - Phone:715-698-2742
Mailing Address - Fax:
Practice Address - Street 1:N750 DOUG BLEGEN DR
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:WI
Practice Address - Zip Code:54767-8806
Practice Address - Country:US
Practice Address - Phone:715-778-4301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI33249-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38328300OtherPROVIDER NUMBER