Provider Demographics
NPI:1346251618
Name:BASS, LISA SMITH (NP)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:SMITH
Last Name:BASS
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:5352 HAMPSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55419-1433
Mailing Address - Country:US
Mailing Address - Phone:612-824-6129
Mailing Address - Fax:
Practice Address - Street 1:1 VETERANS DR
Practice Address - Street 2:111C
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55417-2309
Practice Address - Country:US
Practice Address - Phone:612-467-3647
Practice Address - Fax:612-727-5668
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN101504-9363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health