Provider Demographics
NPI:1093741886
Name:MILES, LISA ANN (CNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:MILES
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ANN
Other - Last Name:HERSCHLIP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NURES PRACTITIONER
Mailing Address - Street 1:4301 ELLIOT AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-3156
Mailing Address - Country:US
Mailing Address - Phone:512-708-7562
Mailing Address - Fax:
Practice Address - Street 1:2900 THOMAS AVE S STE 100
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55416
Practice Address - Country:US
Practice Address - Phone:612-979-2276
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2021-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR125294-1163WG0000X
MN3654363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1093741886OtherPATIENT CHOICE
MN107D0MIOtherBCBS
MN1093741886OtherMEDICA
MN1093741886OtherPREFERRED ONE
MNHP 23925OtherHEALTHPARTNERS
MN1093741886OtherPCHP
MN500008053Medicaid