Lisa Danita Ettienne, DNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

F04210251 Issued in WI

Practice address

4375 N 53Rd St
Milwaukee, WI 53216-1356

Phone

(414) 462-8350

NPI assigned

May 13, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Lisa Danita Payne Former name

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Samir Mullick MD SC

  • Pediatrics Physician
  • Milwaukee, WI
  • NPI 1235182221
  NPD (past)

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

{
    "created_epoch": "1620864000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620864000000",
    "number": "1568036630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4375 N 53RD ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532161356",
            "telephone_number": "414-462-8350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4375 N 53RD ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532161356",
            "telephone_number": "414-462-8350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETTIENNE",
        "first_name": "LISA",
        "middle_name": "DANITA",
        "name_prefix": "Dr.",
        "credential": "DNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-05-13",
        "last_updated": "2021-05-13",
        "certification_date": "2021-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WI",
            "license": "F04210251",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "PAYNE",
            "middle_name": "DANITA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Mariah Estill
• Maria Estrada
• Eternal Love LLC
• Ethereal Muse Collective LLC
• Nancy J Etter, PA
• Carol M Etzel, NP
• Lauren Etzkorn, MD
• Ashley Eubanks
• Euphoric Family Services
• Evan and Joan Wright House of Love LLC

• Family Nurse Practitioner in Milwaukee, WI
• Providers in Milwaukee, WI by specialty
• Family Nurse Practitioner in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 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.

Verify at the official NPI Registry.