# LISA BERNTSON DORNICK

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1992743884
- **Gender:** F
- **Credential:** PNP

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0200X | Pediatric Nurse Practitioner | R-101808-8 | MN | Yes |

## Other

- **Enumeration date:** 06/03/2006
- **Last updated:** 09/21/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 782314200 | — | MN |