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Individual

MRS. LISA BORDEAUX

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CNP

Contact information

Practice address
4040 COON RAPIDS BLVD NW, SUITE 120, MINNEAPOLIS, MN 55433-2522
(763) 427-9980
(763) 427-9908
Mailing address
4040 COON RAPIDS BLVD NW, SUITE 120, MINNEAPOLIS, MN 55433-2522
(763) 427-9980
(763) 427-9908

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
3228
MN
363L00000X
Nurse Practitioner
R1222515
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
771170100
MN
Enumeration date
06/14/2006
Last updated
06/17/2019
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