Provider Demographics
NPI:1326889379
Name:BURKHART, LISA MARIE
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:BURKHART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9451 E ELM RD
Mailing Address - Street 2:
Mailing Address - City:POPLAR
Mailing Address - State:WI
Mailing Address - Zip Code:54864-9071
Mailing Address - Country:US
Mailing Address - Phone:218-391-8068
Mailing Address - Fax:
Practice Address - Street 1:6571 AFTER HOURS RD
Practice Address - Street 2:
Practice Address - City:BRULE
Practice Address - State:WI
Practice Address - Zip Code:54820
Practice Address - Country:US
Practice Address - Phone:608-647-1173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI165651-30163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health