Healthcare Provider Details

I. General information

NPI: 1700457264
Provider Name (Legal Business Name): LISA GENELL URBANIAK WHNP, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2021
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 S MADISON ST
APPLETON WI
54915-1844
US

IV. Provider business mailing address

1611 S MADISON ST
APPLETON WI
54915-1844
US

V. Phone/Fax

Practice location:
  • Phone: 920-738-2000
  • Fax:
Mailing address:
  • Phone: 920-738-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number10917
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: