Individual
LISA MIX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN CCM
Contact information
Practice address
55 454TH BLVD, HARRIS, MN 55032-4000
(651) 334-5671
Mailing address
1391 NW 136TH AVE, SUNRISE, FL 33323-2800
(612) 400-4652
Taxonomy
Speciality
Code
Description
License number
State
163WC0400X
Case Management Registered Nurse
221730-30
WI
163WC0400X
Case Management Registered Nurse
4241198
MN
163WC0400X
Case Management Registered Nurse
Primary
R141093-2
MN
Other
Enumeration date
02/17/2022
Last updated
02/17/2022
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