Provider Demographics
NPI:1629401708
Name:NORDQUIST, LISA MARIE (DVM)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:NORDQUIST
Suffix:
Gender:F
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5502 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55807-2538
Mailing Address - Country:US
Mailing Address - Phone:218-628-0301
Mailing Address - Fax:218-628-1448
Practice Address - Street 1:5503 GRAND AVE
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55807-2537
Practice Address - Country:US
Practice Address - Phone:218-628-0301
Practice Address - Fax:218-628-1448
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN09108174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian