Individual
LISA VANWATERMULEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, NP
Contact information
Practice address
1230 E MAIN ST, MANKATO, MN 56001-5066
(507) 625-1811
Mailing address
1230 E MAIN ST, MANKATO, MN 56001-5066
(507) 625-1811
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R145777-5
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
308637300
—
MN
01
—
37M90VA
BCBSM
MN
01
—
P00602861
RR MEDICARE
MN
Enumeration date
03/27/2007
Last updated
09/28/2011
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