Ristau, Lisa Sue

Ristau, Lisa Sue is an individual health care provider with primary practice located at 4536 22Nd Ave , Kenosha WI 53140-5917. She recently has only one registered license in Dental Providers / Dental Hygienist, which is considered as her primary health care specialty. Ristau, Lisa Sue can be contacted via phone (262) 656-0044.

Contact Information

Primary practice address
4536 22Nd Ave Kenosha WI 53140-5917
Phone: (262) 656-0044
Fax: (262) 653-2218
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Dental Hygienist 124Q00000X 6917-016 Wisconsin

Profile Details

NPI number 1952476632
LBN Legal business name Ristau, Lisa Sue
Credentials Registered Dental Hygienist (RDH)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 21st, 2006
Last updated Jul 9th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1952476632 NPPES
Wisconsin MEDICAID 33805500

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