Individual
LIA PENDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
3119 WOODMAN DR, ALTOONA, WI 54720-2668
(920) 496-4700
Mailing address
3119 WOODMAN DR, ALTOONA, WI 54720-2668
(920) 496-4700
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
13324-33
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100224934
—
WI
Enumeration date
10/26/2022
Last updated
01/18/2024
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