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NPI Code Detail

MEDICARE: LISA FORTMAN

MEDICARE: LISA FORTMAN
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
1172V00000XCommunity Health Worker

General Provider Information

NPI Number : 1760368385
Entity Type Code : Individual
Provider Name (Legal Business Name) : LISA FORTMAN
Provider Business Mailing Address
First Line : 1440 DUCKWOOD DR STE 500
Second Line :
City : EAGAN
State : MN
Zip : 55122-1399
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1440 DUCKWOOD DR STE 500
Second Line :
City : EAGAN
State : MN
Zip : 55122-1399
Country : US
Telephone Number : 952-955-9399
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/12/2025
Last Update Date : 08/12/2025

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Directions to “ LISA FORTMAN ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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