Individual
LISA MAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
333 SMITH AVE N, SAINT PAUL, MN 55102-2344
(651) 735-0501
(651) 735-1870
Mailing address
8100 NORTHLAND DR, BLOOMINGTON, MN 55431-4800
(651) 251-8021
(651) 251-8050
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R1084368
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
755827900
—
MN
Enumeration date
09/14/2006
Last updated
04/17/2017
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