Individual
MARTHA J LYSTAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
19120 200TH ST, GREENBUSH, MN 56726-9280
(218) 782-2400
Mailing address
PO BOX 6002, GRAND FORKS, ND 58206-6002
(701) 780-5000
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R114162-5
MN
Other
Enumeration date
09/27/2006
Last updated
10/13/2020
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