Healthcare Provider Details

I. General information

NPI: 1033641758
Provider Name (Legal Business Name): MEGAN LIFTO APRN, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 UNIVERSITY AVE W FL 6
SAINT PAUL MN
55104-3727
US

IV. Provider business mailing address

995 17TH ST
NEWPORT MN
55055-1609
US

V. Phone/Fax

Practice location:
  • Phone: 651-232-2273
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberCNS 0496
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: