Individual
LISA JO LIEDKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APNP
Contact information
Practice address
210 WISCONSIN AMERICAN DR, FOND DU LAC, WI 54937-2999
(920) 907-7000
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
9728
WI
363LX0106X
Occupational Health Nurse Practitioner
9728
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100095421
—
WI
Enumeration date
11/05/2019
Last updated
11/25/2025
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