Individual
LEE ANN MISSTISHIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1200 6TH AVE N, SAINT CLOUD, MN 56303-2735
(320) 252-5131
Mailing address
2205 MEADOW OAK AVE APT 351, MONTICELLO, MN 55362-2618
(570) 691-5612
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
12453
MN
Other
Enumeration date
07/21/2017
Last updated
07/21/2017
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