MEDICARE: LISA KAE FEESE RN CDE FNP

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	R1049604	MN

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0110908	OTHER	MN	MEDICA CHOICE
3	66D39FE	OTHER	MN	BLUE CROSS BLUE SHIELD
4	3300003	OTHER	MN	MEDICA PRIMARY
5	410999025	OTHER	MN	TRICARE
6	HP42395	OTHER	MN	HEALTH PARTNERS
7	0256006	OTHER	MN	SELECT CARE
8	960541020895	OTHER	MN	PREFERRED ONE

NPI Number	:	1033173620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA KAE FEESE RN CDE FNP

Provider Business Mailing Address
First Line	:	7701 YORK AVE S
Second Line	:	SUITE 180
City	:	EDINA
State	:	MN
Zip	:	55435-5845
Country	:	US
Telephone Number	:	952-927-7810
Fax Number	:	952-927-6309

Provider Business Practice Location Address
First Line	:	7701 YORK AVE S
Second Line	:	SUITE 180
City	:	EDINA
State	:	MN
Zip	:	55435-5845
Country	:	US
Telephone Number	:	952-927-7810
Fax Number	:	952-927-6309

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2006
Last Update Date	:	05/06/2008

7701 YORK AVE S STE 140
EDINA, MN
55435-5845

Practice Phone: 952-956-6700
Practice Fax:

7701 YORK AVE S STE 180
EDINA, MN
55435-5845