Provider Demographics
NPI:1801184411
Name:STAY, LISA M (NP-C)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:STAY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:M
Other - Last Name:SCHIRMERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:425 7TH ST NW
Mailing Address - Street 2:
Mailing Address - City:CASS LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:56633-3360
Mailing Address - Country:US
Mailing Address - Phone:218-335-3200
Mailing Address - Fax:218-335-3408
Practice Address - Street 1:425 7TH ST NW
Practice Address - Street 2:
Practice Address - City:CASS LAKE
Practice Address - State:MN
Practice Address - Zip Code:56633-3360
Practice Address - Country:US
Practice Address - Phone:218-335-3200
Practice Address - Fax:218-335-3408
Is Sole Proprietor?:No
Enumeration Date:2011-07-17
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR157183-9363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1801184411Medicaid
MNPTAN 500006901Medicare PIN