Healthcare Provider Details

I. General information

NPI: 1932180973
Provider Name (Legal Business Name): LISA MARY GALL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 03/26/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35294 LOGAN LN
HILLMAN MN
56338-2445
US

IV. Provider business mailing address

35294 LOGAN LANE
HILLMAN MN
56338
US

V. Phone/Fax

Practice location:
  • Phone: 320-277-3078
  • Fax:
Mailing address:
  • Phone: 320-630-9116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR1085286
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code163WM1400X
TaxonomyNurse Massage Therapist (NMT)
License NumberR1085286
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberR1085286
License Number StateMN
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR1085286
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: