Active NPI
Lisa Brennan, FNP
- Family Nurse Practitioner
- Fond Du Lac, WI
National Provider Identifier
1417628702
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 11148-33
- Practice address
- 912 S Hickory St
Fond Du Lac, WI 54935-5530 - Phone
- (920) 907-3922
- NPI assigned
- Sep 25, 2021
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 11148-33 | WI | Primary |
Addresses
Primary practice location
912 S Hickory St
Fond Du Lac, WI 54935-5530
Mailing address
1964 Chippewa CT
Grafton, WI 53024-2833
Phone (262) 618-4075
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11148-33 | WI | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1632528000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1632528000000",
"number": "1417628702",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1964 CHIPPEWA CT",
"city": "GRAFTON",
"state": "WI",
"postal_code": "530242833",
"telephone_number": "262-618-4075"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "912 S HICKORY ST",
"city": "FOND DU LAC",
"state": "WI",
"postal_code": "549355530",
"telephone_number": "920-907-3922"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRENNAN",
"first_name": "LISA",
"credential": "FNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-09-25",
"last_updated": "2021-09-25",
"certification_date": "2021-09-25",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "WI",
"license": "11148-33",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fond Du Lac, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.