Individual
MRS. JULIE LISOWSKI DAHL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3366 OAKDALE AVE N STE 605, ROBBINSDALE, MN 55422-5700
(763) 520-2940
Mailing address
1200 PRESTWICK TER, MAHTOMEDI, MN 55115-2860
(651) 730-4805
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
R1232453
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0405560
MEDICA
MN
01
—
1016580
PO
MN
01
—
122717
UCARE
MN
01
—
26294
HP
MN
01
—
500002364
WPS MEDICARE
MN
01
—
552S5DA
BCBS
MN
05
—
733317000
—
MN
01
—
P00005587
RAILROAD MEDICARE
MN
Enumeration date
01/08/2007
Last updated
04/23/2014
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