MEDICARE: LISA MARY GALL NP

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	163W00000X	Registered Nurse	R1085286	MN
2	163WM1400X	Nurse Massage Therapist (NMT)	R1085286	MN
3	251J00000X	Nursing Care Agency	R1085286	MN
4	363LF0000X	Family Nurse Practitioner	R1085286	MN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00172825	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	HP46368	OTHER	HEALTH PARTNERS
2	2172434	OTHER	ARAZ GROUP AMERICAS PPO
4	132230	OTHER	UCARE
5	312K8GA	OTHER	BLUE CROSS BLUE SHIELD
6	0118421	OTHER	MEDICA HEALTH PLANS
7	548522300	OTHER	MEDICAL ASSISTANCE
8	1041752	OTHER	PREFERRED ONE

General Provider Information

NPI Number	:	1932180973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA MARY GALL NP

Provider Business Mailing Address
First Line	:	35294 LOGAN LANE
Second Line	:
City	:	HILLMAN
State	:	MN
Zip	:	56338
Country	:	US
Telephone Number	:	320-630-9116
Fax Number	:

Provider Business Practice Location Address
First Line	:	35294 LOGAN LN
Second Line	:
City	:	HILLMAN
State	:	MN
Zip	:	56338-2445
Country	:	US
Telephone Number	:	320-277-3078
Fax Number	:

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

Provider Enumeration Date	:	11/08/2005
Last Update Date	:	03/26/2025

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Directions to “ LISA MARY GALL NP” Practice Location

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