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Individual

LISA N VON WALD

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
AGPCNP-BC

Contact information

Practice address
500 HARVARD ST SE, MINNEAPOLIS, MN 55455-0363
(612) 273-3000
Mailing address
500 HARVARD ST SE, MINNEAPOLIS, MN 55455-0363
(612) 273-3000

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R179726-0
MN
363L00000X
Nurse Practitioner
Primary
2013006750
MN

Other

Enumeration date
07/31/2013
Last updated
08/08/2013
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