Individual
JENNIFER LAIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1 VETERANS DR, MINNEAPOLIS, MN 55417-2309
(612) 467-3285
Mailing address
18136 211TH AVE NW, BIG LAKE, MN 55309-9642
(763) 489-8055
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
R 205488-9
MN
363LA2200X
Adult Health Nurse Practitioner
Primary
50549
ND
363LG0600X
Gerontology Nurse Practitioner
50549
ND
Other
Enumeration date
04/23/2015
Last updated
10/29/2022
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