Lesa Povletich, RN

Primary specialty

Registered NurseTaxonomy code 163W00000X

License

1087676-30 Issued in WI

Practice address

1333 College Ave Ste M1
South Milwaukee, WI 53172-1150

Phone

(414) 775-2500

Fax

(414) 301-9328

NPI assigned

Sep 2, 2022

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1662076800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662076800000",
    "number": "1154042612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8444 N 90TH ST STE 100",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852584437",
            "telephone_number": "602-248-8886",
            "fax_number": "480-687-7316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1333 COLLEGE AVE STE M1",
            "city": "SOUTH MILWAUKEE",
            "state": "WI",
            "postal_code": "531721150",
            "telephone_number": "414-775-2500",
            "fax_number": "414-301-9328"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "POVLETICH",
        "first_name": "LESA",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-09-02",
        "last_updated": "2022-09-02",
        "certification_date": "2022-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WI",
            "license": "1087676-30",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Steven Christopher Penn
• Larry John Pleva, P.T.
• Jacqueline Lee Polakowski, COTA
• Potisk Chiropractic Office, S.C.
• Thomas Potisk, DC
• Premier Care of Wisconsin, LLC.
• Premier Care of Wisconsin, LLC.
• Premise Health of Connecticut Medical, P.C.
• Madeline Preston, OTD
• R&D Care Journey LLC

• Registered Nurse in South Milwaukee, WI
• Providers in South Milwaukee, WI by specialty
• Registered Nurse in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.