MEDICARE: CATHERINE LILA WISNER MSN

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	R1079836	MN

General Provider Information

NPI Number	:	1669466264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE LILA WISNER MSN

Provider Business Mailing Address
First Line	:	4801 W 59TH ST
Second Line	:
City	:	EDINA
State	:	MN
Zip	:	55424-1704
Country	:	US
Telephone Number	:	952-285-4382
Fax Number	:

Provider Business Practice Location Address
First Line	:	333 WASHINGTON AVE N
Second Line	:	SUITE 5000
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55401-1377
Country	:	US
Telephone Number	:	612-659-7111
Fax Number	:	612-659-7101

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

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	07/08/2007

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