Provider Demographics
NPI:1558602011
Name:FINE, LISA ANN (RN)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ANN
Last Name:FINE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 HORSESHOE LN
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-9400
Mailing Address - Country:US
Mailing Address - Phone:507-345-8591
Mailing Address - Fax:
Practice Address - Street 1:104 HORSESHOE LN
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-9400
Practice Address - Country:US
Practice Address - Phone:507-345-8591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-08
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR2022604163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management