Active NPI
Lisa M Bender, LPN
- General Practice Physician
- Oregon, WI
National Provider Identifier
1104458025
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 310675-31
- Practice address
- 213 Bergamont Blvd Apt 101
Oregon, WI 53575-3722 - Phone
- (325) 320-4165
- NPI assigned
- Feb 8, 2020
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 310675-31 | WI | Primary |
Addresses
Primary practice location
213 Bergamont Blvd Apt 101
Oregon, WI 53575-3722
Mailing address
1207 Vista Ave
Janesville, WI 53545-4942
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 310675-31 | WI | MD | General Practice Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1581120000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1581120000000",
"number": "1104458025",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1207 VISTA AVE",
"city": "JANESVILLE",
"state": "WI",
"postal_code": "535454942"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "213 BERGAMONT BLVD APT 101",
"city": "OREGON",
"state": "WI",
"postal_code": "535753722",
"telephone_number": "325-320-4165"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENDER",
"first_name": "LISA",
"middle_name": "M",
"credential": "LPN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-02-08",
"last_updated": "2020-02-08",
"certification_date": "2020-02-08",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "WI",
"license": "310675-31",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oregon, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.