Healthcare Provider Details

I. General information

NPI: 1366401143
Provider Name (Legal Business Name): LISA M RENARD PAULE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 03/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 HARDING ST NE STE 100
MINNEAPOLIS MN
55413-2801
US

IV. Provider business mailing address

401 HARDING ST NE STE 100
MINNEAPOLIS MN
55413-2801
US

V. Phone/Fax

Practice location:
  • Phone: 651-571-0000
  • Fax:
Mailing address:
  • Phone: 651-571-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberCNP825
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP825
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: