Provider Demographics
NPI:1811939275
Name:CUNAT, LISA M (PAC)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:CUNAT
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1745 CARRIAGE DR
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:MN
Mailing Address - Zip Code:55386-4512
Mailing Address - Country:US
Mailing Address - Phone:952-679-4801
Mailing Address - Fax:
Practice Address - Street 1:8170 OLD CARRIAGE CT STE 100
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-3164
Practice Address - Country:US
Practice Address - Phone:952-428-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10154363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP30153Medicare UPIN
FLE5425XMedicare ID - Type Unspecified