Healthcare Provider Details

I. General information

NPI: 1699903807
Provider Name (Legal Business Name): LISA ELAINE THOM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LISA ELAINE RHYNER M.D.

II. Dates (important events)

Enumeration Date: 06/25/2009
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3860 MONROE RD
DE PERE WI
54115-8399
US

IV. Provider business mailing address

PO BOX 19070
GREEN BAY WI
54307-9070
US

V. Phone/Fax

Practice location:
  • Phone: 920-496-4700
  • Fax:
Mailing address:
  • Phone: 920-496-4700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA116471
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number49538
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number65907-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: