Healthcare Provider Details

I. General information

NPI: 1952851677
Provider Name (Legal Business Name): LISA WILLMS CD(DONA)
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2016
Last Update Date: 02/26/2024
Certification Date: 02/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 JACKSON ST NE STE 100
MINNEAPOLIS MN
55413-3051
US

IV. Provider business mailing address

120 DEMONT AVE E APT 102
LITTLE CANADA MN
55117-1528
US

V. Phone/Fax

Practice location:
  • Phone: 612-353-6293
  • Fax:
Mailing address:
  • Phone: 612-353-6293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: