Provider Demographics
NPI:1326376096
Name:NEWCOMER, LISA B (CNP)
Entity Type:Individual
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First Name:LISA
Middle Name:B
Last Name:NEWCOMER
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Gender:F
Credentials:CNP
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Mailing Address - Street 1:2104 NORTHDALE BLVD NW
Mailing Address - Street 2:SUITE 220
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-3028
Mailing Address - Country:US
Mailing Address - Phone:763-537-6000
Mailing Address - Fax:763-537-6666
Practice Address - Street 1:9550 UPLAND LN N
Practice Address - Street 2:SUITE 100
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-4481
Practice Address - Country:US
Practice Address - Phone:763-537-6000
Practice Address - Fax:763-537-6666
Is Sole Proprietor?:No
Enumeration Date:2009-11-18
Last Update Date:2019-02-13
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Provider Licenses
StateLicense IDTaxonomies
MN1075208VP0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine