Healthcare Provider Details

I. General information

NPI: 1881053601
Provider Name (Legal Business Name): LISA BURKAUSKAS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2016
Last Update Date: 02/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 42ND AVE N
NEW HOPE MN
55427-1100
US

IV. Provider business mailing address

8200 42ND AVE N
NEW HOPE MN
55427-1100
US

V. Phone/Fax

Practice location:
  • Phone: 763-581-0962
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP 4196
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: