Provider Demographics
NPI:1750684049
Name:TERHAAR, LISA MARIE (CNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:TERHAAR
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 62ND ST
Mailing Address - Street 2:
Mailing Address - City:LINO LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:55014-1442
Mailing Address - Country:US
Mailing Address - Phone:612-406-7200
Mailing Address - Fax:
Practice Address - Street 1:550 62ND ST
Practice Address - Street 2:
Practice Address - City:CIRCLE PINES
Practice Address - State:MN
Practice Address - Zip Code:55014-1442
Practice Address - Country:US
Practice Address - Phone:612-406-7200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-08
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR124303363LG0600X
MNR 124303-1363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology