Provider Demographics
NPI:1033173620
Name:FEESE, LISA KAE (RN CDE FNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:KAE
Last Name:FEESE
Suffix:
Gender:F
Credentials:RN CDE FNP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:KAE
Other - Last Name:HILSTAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, CDE
Mailing Address - Street 1:7701 YORK AVE S
Mailing Address - Street 2:SUITE 180
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-5845
Mailing Address - Country:US
Mailing Address - Phone:952-927-7810
Mailing Address - Fax:952-927-6309
Practice Address - Street 1:7701 YORK AVE S
Practice Address - Street 2:SUITE 180
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-5845
Practice Address - Country:US
Practice Address - Phone:952-927-7810
Practice Address - Fax:952-927-6309
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1049604363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN743061200Medicaid
MN0110908OtherMEDICA CHOICE
MN66D39FEOtherBLUE CROSS BLUE SHIELD
MN3300003OtherMEDICA PRIMARY
MN410999025OtherTRICARE
MNHP42395OtherHEALTH PARTNERS
MN0256006OtherSELECT CARE
MN960541020895OtherPREFERRED ONE
MN500000873Medicare ID - Type Unspecified
MNHP42395OtherHEALTH PARTNERS
MN960541020895OtherPREFERRED ONE