Healthcare Provider Details

I. General information

NPI: 1326009630
Provider Name (Legal Business Name): LISA D BOJADO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2006
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2854 HIGHWAY 55 STE 130
EAGAN MN
55121-1447
US

IV. Provider business mailing address

2854 HIGHWAY 55 STE 130
EAGAN MN
55121-1447
US

V. Phone/Fax

Practice location:
  • Phone: 651-842-3328
  • Fax: 651-842-3391
Mailing address:
  • Phone: 651-842-3328
  • Fax: 651-842-3391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5289
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF332670
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: