Individual
LISA LAVONN LONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN CNS
Contact information
Practice address
2800 CAMPUS DR, SUITE 30, PLYMOUTH, MN 55441-2645
(763) 398-2203
(763) 398-2233
Mailing address
DIVISION OF VASCULAR SURGERY, MMC 195, 420 DELAWARE STREET SE MMC 195, MINNEAPOLIS, MN 55455
(612) 626-4893
Taxonomy
Speciality
Code
Description
License number
State
364SA2200X
Adult Health Clinical Nurse Specialist
Primary
R1414190
MN
Other
Enumeration date
01/17/2008
Last updated
06/27/2018
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