Lisa Berntson Dornick, PNP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

R-101808-8 Issued in MN

Practice address

250 S 4TH St
Minneapolis, MN 55415-1384

Phone

(612) 673-2301

Fax

(612) 673-3866

NPI assigned

Jun 3, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• City of Minneapolis

  • Student Health Clinic/Center
  • Minneapolis, MN
  • NPI 1598817678
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1348185600000",
    "number": "1992743884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 S 4TH ST",
            "address_2": "ROOM 250",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554151384",
            "telephone_number": "612-673-2301",
            "fax_number": "612-673-3866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 S 4TH ST",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554151384",
            "telephone_number": "612-673-2301",
            "fax_number": "612-673-3866"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DORNICK",
        "first_name": "LISA",
        "middle_name": "BERNTSON",
        "credential": "PNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-03",
        "last_updated": "2012-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MN",
            "license": "R-101808-8",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "782314200",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michelle Lynn Dornan-Vickery
• Brianna Elizabeth Dornan
• Sumitra Dorner
• Bradleigh J Dornfeld, MD
• Cheryl Dornfeld, LPCC
• John Z Doroschak, DDS
• Michael Dennis Doroschak, DDS
• Iftu G Dorose
• Jodi Marie Dorpinghaus, D.C.
• Kathryn Marie Dorr, P.A.

• Pediatric Nurse Practitioner in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Pediatric Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.