Individual
LISA GUNDERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1836 SOUTH AVE, LA CROSSE, WI 54601-5429
(608) 782-7300
Mailing address
1836 SOUTH AVE, LA CROSSE, WI 54601-5429
(608) 782-7300
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
4262
WI
363AM0700X
Medical Physician Assistant
902
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
902
PA LIC
CO
Enumeration date
07/17/2007
Last updated
01/23/2018
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