Lisa Anne Doom, RN
Individual provider Active NPI Registered Nurse · Plymouth, MN
NPI 1316420482 · NPPES record last updated Sep 13, 2018
Key facts
- NPI
- 1316420482
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- R1319981 (MN)
- Practice address
- 6055 Nathan LN N
Plymouth, MN 55442-1674 - Phone
- (763) 513-4392
- NPI assigned
- Sep 13, 2018
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R1319981 | MN | MD | Registered Nurse |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | R1319981 | MN | Yes |
Addresses
Primary practice location
6055 Nathan LN N
Plymouth, MN 55442-1674
Mailing address
1124 10TH Ave
Granite Falls, MN 56241-1231
Phone (507) 430-9215
Other providers in Plymouth, MN
- Samantha Domagala
- Alyssa Marie Domico
- Don Sealock, O.D., P.a.
- Alicia Mae Donahue
- Delaney Kyl Donohue
- Michael Zetune Dorfman
- Britta Anne Dosland
- Cynthia Doth
- Anne Doucette
- Jeffrey Allen Doughty
All providers in Plymouth, MN · Registered Nurse in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 13, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.