Provider Demographics
NPI:1215243852
Name:LEASE, RITA M (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:M
Last Name:LEASE
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Gender:F
Credentials:PMHNP-BC
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Mailing Address - Street 1:770 LINCOLN AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FENNIMORE
Mailing Address - State:WI
Mailing Address - Zip Code:53809-1562
Mailing Address - Country:US
Mailing Address - Phone:608-572-3494
Mailing Address - Fax:608-822-3812
Practice Address - Street 1:770 LINCOLN AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:FENNIMORE
Practice Address - State:WI
Practice Address - Zip Code:53809-1562
Practice Address - Country:US
Practice Address - Phone:608-572-3494
Practice Address - Fax:608-822-3812
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-20
Last Update Date:2016-10-17
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Provider Licenses
StateLicense IDTaxonomies
WI4062-33363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health