Healthcare Provider Details

I. General information

NPI: 1093986325
Provider Name (Legal Business Name): LISA A BUSE M.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2008
Last Update Date: 03/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 NORTH LAKE AVE
TWIN LAKES WI
53181
US

IV. Provider business mailing address

210 NORTH LAKE AVENUE
TWIN LAKES WI
53181
US

V. Phone/Fax

Practice location:
  • Phone: 262-877-4446
  • Fax: 262-877-3574
Mailing address:
  • Phone: 262-877-4446
  • Fax: 262-877-3574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: