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NPI Code Detail

MEDICARE: LIZA UKHANOVA FNP-BC

MEDICARE: LIZA UKHANOVA FNP-BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner2009008877WI
2363LF0000XFamily Nurse Practitioner4050-33WI

General Provider Information

NPI Number : 1558688747
Entity Type Code : Individual
Provider Name (Legal Business Name) : LIZA UKHANOVA FNP-BC
Provider Business Mailing Address
First Line : 2135 PINE RIDGE CT UNIT A
Second Line :
City : GRAFTON
State : WI
Zip : 53024-3104
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 302 N JACKSON ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53202-5904
Country : US
Telephone Number : 414-271-8045
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/27/2010
Last Update Date : 04/15/2026

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Directions to “ LIZA UKHANOVA FNP-BC” Practice Location

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