Individual
LISA M STAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
425 7TH ST NW, CASS LAKE, MN 56633-3360
(218) 335-3200
(218) 335-3408
Mailing address
425 7TH ST NW, CASS LAKE, MN 56633-3360
(218) 335-3200
(218) 335-3408
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R157183-9
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1801184411
—
MN
Enumeration date
07/17/2011
Last updated
03/30/2022
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