Provider Demographics
NPI:1225186869
Name:DAHL, JULIE LISOWSKI
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:LISOWSKI
Last Name:DAHL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 PRESTWICK TER
Mailing Address - Street 2:
Mailing Address - City:MAHTOMEDI
Mailing Address - State:MN
Mailing Address - Zip Code:55115-2860
Mailing Address - Country:US
Mailing Address - Phone:651-730-4805
Mailing Address - Fax:
Practice Address - Street 1:3366 OAKDALE AVE N STE 605
Practice Address - Street 2:
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422-5700
Practice Address - Country:US
Practice Address - Phone:763-520-2940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1232453363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1016580OtherPO
MN26294OtherHP
MN552S5DAOtherBCBS
MN500002364OtherWPS MEDICARE
MN0405560OtherMEDICA
MN122717OtherUCARE
MN733317000Medicaid
MNP00005587OtherRAILROAD MEDICARE
MN500002364Medicare PIN
MN122717OtherUCARE
MN500002364Medicare ID - Type Unspecified
MN1016580OtherPO