Provider Demographics
NPI:1700063609
Name:DAHLQUIST, LISA K (CRNA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:K
Last Name:DAHLQUIST
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6465 WAYZATA BLVD
Mailing Address - Street 2:STE 210
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55426-1728
Mailing Address - Country:US
Mailing Address - Phone:952-993-0662
Mailing Address - Fax:952-993-0300
Practice Address - Street 1:6465 WAYZATA BLVD
Practice Address - Street 2:STE 210
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55426-1728
Practice Address - Country:US
Practice Address - Phone:952-993-7169
Practice Address - Fax:952-993-0300
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR169210-3163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse