Healthcare Provider Details

I. General information

NPI: 1457373581
Provider Name (Legal Business Name): LISA MARY TUSZKA APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 11/10/2022
Certification Date: 11/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2845 GREENBRIER RD
GREEN BAY WI
54311-6519
US

IV. Provider business mailing address

3301 W FOREST HOME AVE
MILWAUKEE WI
53215-2843
US

V. Phone/Fax

Practice location:
  • Phone: 920-288-8400
  • Fax: 920-288-8463
Mailing address:
  • Phone: 920-288-8400
  • Fax: 920-288-8463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1994
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: