Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 4472-33 | WI |
NPI | 1063762755 |
---|---|
Provider Name | Lisa M Piontek |
First Address | Green Bay, WI 54307-3508 |
Second Address | Green Bay, WI 54301-3526 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/09/2012 |
Last Update Date | 27/12/2021 |