Provider Demographics
NPI:1962472332
Name:CHRISTIANSEN, LISA R (WHCNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:R
Last Name:CHRISTIANSEN
Suffix:
Gender:F
Credentials:WHCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4227 LILAC AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHWOOD
Mailing Address - State:IA
Mailing Address - Zip Code:50459-8531
Mailing Address - Country:US
Mailing Address - Phone:515-845-2012
Mailing Address - Fax:
Practice Address - Street 1:1212 7TH ST NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-1733
Practice Address - Country:US
Practice Address - Phone:507-288-5186
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAF081668363LW0102X
MNR1176933363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN615S8CHOtherBCBS MN
MN882903900Medicaid
07-00927OtherMEDICA
HP30389OtherHEALTH PARTNERS
1023191OtherPREFERRED ONE
1067914OtherAMERICA'S PPO (ARAZ)
127763OtherUCARE
21399OtherSIOUX VALLEY HEALTH PLAN
1023191OtherPREFERRED ONE
1067914OtherAMERICA'S PPO (ARAZ)