Healthcare Provider Details

I. General information

NPI: 1578572806
Provider Name (Legal Business Name): LISA GERI BURNS RN, CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 06/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5520 RIDGEWOOD CV
MOUND MN
55364-8239
US

IV. Provider business mailing address

8685 HUNTERS CT
APPLE VALLEY MN
55124-9413
US

V. Phone/Fax

Practice location:
  • Phone: 612-865-5262
  • Fax: 952-431-7763
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberR134891-0
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: