Provider Demographics
NPI:1568290120
Name:CORBINE, LISA MARIE (RN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:CORBINE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:STYS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:4470 S 5TH PL
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53207-4963
Mailing Address - Country:US
Mailing Address - Phone:414-216-4364
Mailing Address - Fax:
Practice Address - Street 1:4470 S 5TH PL
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53207-4963
Practice Address - Country:US
Practice Address - Phone:414-216-4364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI173989-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse