Healthcare Provider Details

I. General information

NPI: 1366412975
Provider Name (Legal Business Name): LISA A OROZCO WHCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 11/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1921 CHICAGO AVE
MINNEAPOLIS MN
55404-1904
US

IV. Provider business mailing address

3516 JERSEY AVE N
CRYSTAL MN
55427-2265
US

V. Phone/Fax

Practice location:
  • Phone: 612-874-1420
  • Fax:
Mailing address:
  • Phone: 612-874-9875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberR134606-4
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: