Healthcare Provider Details

I. General information

NPI: 1912827155
Provider Name (Legal Business Name): LISA ANNE GLASGOW APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3802 OAKWOOD MALL DR
EAU CLAIRE WI
54701-3016
US

IV. Provider business mailing address

2403 FOLSOM ST
EAU CLAIRE WI
54703-2435
US

V. Phone/Fax

Practice location:
  • Phone: 715-839-9280
  • Fax: 715-229-5551
Mailing address:
  • Phone: 715-552-9784
  • Fax: 715-835-6370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number17714-33
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number189695-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: