Basic Information
| Provider Information | |||||||||
| NPI: | 1366611634 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAILEY | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | RNC, NNP-BC, APNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2629 N 7TH ST | ||||||||
| Address2: | |||||||||
| City: | SHEBOYGAN | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530834932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9204515000 | ||||||||
| FaxNumber: | 9204515143 | ||||||||
| Practice Location | |||||||||
| Address1: | 2629 N 7TH ST | ||||||||
| Address2: | |||||||||
| City: | SHEBOYGAN | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530834932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9204515000 | ||||||||
| FaxNumber: | 9204515143 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2008 | ||||||||
| LastUpdateDate: | 01/13/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 3386 | WI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
No ID Information.