Provider Demographics
NPI:1326927245
Name:JABLONOWSKI, LISA (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:JABLONOWSKI
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 BISHOPS WAY STE 102
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-6209
Mailing Address - Country:US
Mailing Address - Phone:262-402-7964
Mailing Address - Fax:
Practice Address - Street 1:333 BISHOPS WAY STE 102
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-6209
Practice Address - Country:US
Practice Address - Phone:414-530-1878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-27
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI17343-33363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty