Provider Demographics
NPI:1548790728
Name:ROHLMAN, LISA CLAIRE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:CLAIRE
Last Name:ROHLMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:CLAIRE
Other - Last Name:RYDEEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3045 EAGANDALE PL. APT. 107
Mailing Address - Street 2:APT. 107
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121
Mailing Address - Country:US
Mailing Address - Phone:715-417-2511
Mailing Address - Fax:
Practice Address - Street 1:640 JACKSON ST.
Practice Address - Street 2:
Practice Address - City:ST. PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101
Practice Address - Country:US
Practice Address - Phone:651-254-3456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-19
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN12485363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant