Healthcare Provider Details

I. General information

NPI: 1457387474
Provider Name (Legal Business Name): LISA SCHILLER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 E GREEN BAY ST
SHAWANO WI
54166-2443
US

IV. Provider business mailing address

PO BOX 8003
APPLETON WI
54912-8003
US

V. Phone/Fax

Practice location:
  • Phone: 715-524-2161
  • Fax: 715-524-5658
Mailing address:
  • Phone: 920-996-3238
  • Fax: 920-738-5787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1044
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: