Healthcare Provider Details

I. General information

NPI: 1295084432
Provider Name (Legal Business Name): LISA K HOVDE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2012
Last Update Date: 06/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 MARKETPOINTE DR STE 100
BLOOMINGTON MN
55435
US

IV. Provider business mailing address

4300 MARKETPOINTE DR STE 100
BLOOMINGTON MN
55435-5435
US

V. Phone/Fax

Practice location:
  • Phone: 952-835-9880
  • Fax: 952-857-1554
Mailing address:
  • Phone: 952-835-9880
  • Fax: 952-857-1554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR 129334-0
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: