Provider Demographics
NPI:1578572806
Name:BURNS, LISA GERI (RN, CNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:GERI
Last Name:BURNS
Suffix:
Gender:F
Credentials:RN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8685 HUNTERS CT
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55124-9413
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5520 RIDGEWOOD CV
Practice Address - Street 2:
Practice Address - City:MOUND
Practice Address - State:MN
Practice Address - Zip Code:55364-8239
Practice Address - Country:US
Practice Address - Phone:612-865-5262
Practice Address - Fax:952-431-7763
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR134891-0363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0549029-00Medicaid
MN0549029-00Medicaid
MN500002933Medicare ID - Type Unspecified