Provider Demographics
NPI:1932180973
Name:GALL, LISA M (CFNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:GALL
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35294 LOGAN LANE
Mailing Address - Street 2:
Mailing Address - City:HILLMAN
Mailing Address - State:MN
Mailing Address - Zip Code:56338
Mailing Address - Country:US
Mailing Address - Phone:320-277-3078
Mailing Address - Fax:
Practice Address - Street 1:35294 LOGAN LN
Practice Address - Street 2:
Practice Address - City:HILLMAN
Practice Address - State:MN
Practice Address - Zip Code:56338-2445
Practice Address - Country:US
Practice Address - Phone:320-277-3078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1085286363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
HP46368OtherHEALTH PARTNERS
P00172825OtherRAILROAD MEDICARE
548522300OtherMEDICAL ASSISTANCE
1041752OtherPREFERRED ONE
132230OtherUCARE
0118421OtherMEDICA HEALTH PLANS
2172434OtherARAZ GROUP AMERICAS PPO
312K8GAOtherBLUE CROSS BLUE SHIELD
MG0707628OtherDEA
2172434OtherARAZ GROUP AMERICAS PPO
500002703Medicare ID - Type Unspecified