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General NPI Number Information
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NPI Number | 1740992023
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Entity Type | Individual
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Provider Name | LISA MYHRE PMHNP
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Gender | Female
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Dates
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Enumeration Date | 12/19/2022
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Last Update Date | 12/19/2022
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Provider Practice Location Address
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Address Line | 300 4TH ST N
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City | LA CROSSE
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State | WI
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Zip | 54601-3228
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Country | US
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Telephone | 608-784-4357
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Fax |
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Provider Business Mailing Address
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Address Line | 221 2ND ST SW
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City | SPRING GROVE
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State | MN
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Zip | 55974-1107
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Country | US
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Telephone | 612-327-1592
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 13401-33
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License Number State | WI
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