Provider Demographics
NPI:1639486368
Name:NEUMILLER, LISA M (NFP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:NEUMILLER
Suffix:
Gender:F
Credentials:NFP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 BREWSTER ST E
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:ND
Mailing Address - Zip Code:58341-1653
Mailing Address - Country:US
Mailing Address - Phone:701-324-5131
Mailing Address - Fax:701-324-5126
Practice Address - Street 1:317 BREWSTER ST E
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:ND
Practice Address - Zip Code:58341-1653
Practice Address - Country:US
Practice Address - Phone:701-324-5131
Practice Address - Fax:701-324-5126
Is Sole Proprietor?:No
Enumeration Date:2010-09-01
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR31745363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND84228Medicaid