Individual
LISA ROOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1099 10TH AVE SE, MINNEAPOLIS, MN 55414-1312
(651) 789-8767
Mailing address
1099 10TH AVE SE, MINNEAPOLIS, MN 55414-1312
(651) 789-8767
Taxonomy
Speciality
Code
Description
License number
State
163WC0400X
Case Management Registered Nurse
Primary
R2266350
MN
Other
Enumeration date
02/09/2016
Last updated
02/09/2016
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