Healthcare Provider Details

I. General information

NPI: 1043258866
Provider Name (Legal Business Name): LISA ELLEN KROMANAKER R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4122 E TOWNE BLVD
MADISON WI
53704-3732
US

IV. Provider business mailing address

325 GARNET LN
MADISON WI
53714-2552
US

V. Phone/Fax

Practice location:
  • Phone: 608-242-6840
  • Fax: 608-242-6117
Mailing address:
  • Phone: 608-242-7295
  • Fax: 608-249-3171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number105560
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: