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General NPI Number Information
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NPI Number | 1598158784
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Entity Type | Individual
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Provider Name | LISA NIEMCZYK GLOGOWSKI C.R.N.A
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Gender | Female
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Dates
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Enumeration Date | 03/11/2015
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Last Update Date | 02/11/2019
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Provider Practice Location Address
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Address Line | 8990 SPRINGBROOK DR NW STE 250
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City | COON RAPIDS
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State | MN
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Zip | 55433
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Country | US
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Telephone | 763-260-8808
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Fax |
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Provider Business Mailing Address
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Address Line | 10600 250TH ST E
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City | LAKEVILLE
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State | MN
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Zip | 55044-6409
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Country | US
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Telephone | 651-492-4882
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 1772
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License Number State | MN
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