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General NPI Number Information
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NPI Number | 1932151347
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Entity Type | Individual
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Provider Name | LISA I WOLFE APNP
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Gender | Female
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Dates
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Enumeration Date | 05/16/2006
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Last Update Date | 10/28/2013
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Provider Practice Location Address
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Address Line | 516 DELAWARE ST SE CLINIC 1A
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City | MINNEAPOLIS
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State | MN
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Zip | 55455-0356
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Country | US
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Telephone | 612-624-6666
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Fax | 612-624-0644
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Provider Business Mailing Address
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Address Line | 420 DELAWARE ST SE MMC 96 - NEUROSURGERY CLINIC
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City | MINNEAPOLIS
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State | MN
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Zip | 55455-0341
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Country | US
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Telephone | 612-624-6666
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | R124435-7
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License Number State | MN
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