Provider Demographics
NPI:1740992023
Name:MYHRE, LISA (PMHNP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:MYHRE
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 2ND ST SW
Mailing Address - Street 2:
Mailing Address - City:SPRING GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55974-1107
Mailing Address - Country:US
Mailing Address - Phone:612-327-1592
Mailing Address - Fax:
Practice Address - Street 1:300 4TH ST N
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-3228
Practice Address - Country:US
Practice Address - Phone:608-784-4357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-19
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13401-33363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health