Healthcare Provider Details

I. General information

NPI: 1154096964
Provider Name (Legal Business Name): LISA ISLER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. LISA BUCK

II. Dates (important events)

Enumeration Date: 08/12/2021
Last Update Date: 11/04/2021
Certification Date: 11/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 S. WASHINGTON ST
GRAND FORKS ND
58201
US

IV. Provider business mailing address

2401 DEMERS AVE
GRAND FORKS ND
58201
US

V. Phone/Fax

Practice location:
  • Phone: 701-732-7000
  • Fax:
Mailing address:
  • Phone: 701-780-6468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number8620
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR31261
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: