Healthcare Provider Details

I. General information

NPI: 1922059773
Provider Name (Legal Business Name): SHARI K LIESCH APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 07/12/2023
Certification Date: 07/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2575 E EVERGREEN DRIVE
APPLETON WI
54913-8904
US

IV. Provider business mailing address

2575 E EVERGREEN DRIVE
APPLETON WI
54913-8904
US

V. Phone/Fax

Practice location:
  • Phone: 920-969-5353
  • Fax: 414-337-7201
Mailing address:
  • Phone: 920-969-5353
  • Fax: 414-337-7201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2684
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: