Healthcare Provider Details

I. General information

NPI: 1851362214
Provider Name (Legal Business Name): LISA YVONNE BATCHELOR M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LISA YVONNE ROLSTAD M.D.

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12000 ELM CREEK BLVD N SUITE 250
MAPLE GROVE MN
55369-7073
US

IV. Provider business mailing address

3925 OTTAWA AVE S
MINNEAPOLIS MN
55416-3017
US

V. Phone/Fax

Practice location:
  • Phone: 952-401-8300
  • Fax:
Mailing address:
  • Phone: 952-926-7900
  • Fax: 952-380-5371

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number41060
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: