Provider Demographics
NPI:1730498478
Name:ROSENAU, LISA A (LDA)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:A
Last Name:ROSENAU
Suffix:
Gender:F
Credentials:LDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 HILLCREST AVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:OWATONNA
Mailing Address - State:MN
Mailing Address - Zip Code:55060-3680
Mailing Address - Country:US
Mailing Address - Phone:507-451-0290
Mailing Address - Fax:507-451-0291
Practice Address - Street 1:3632 10TH LN NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-7032
Practice Address - Country:US
Practice Address - Phone:507-281-5000
Practice Address - Fax:507-281-5001
Is Sole Proprietor?:No
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNA4779126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant