Individual
LISA MAE RUPERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MSN FNP
Contact information
Practice address
8170 33RD AVE S MS 21110Q, HEALTHPARTNERS FLOATING CLINIC C/O PHYSICIAN SERVICES, MINNEAPOLIS, MN 55440-1309
(952) 883-5375
(952) 883-5395
Mailing address
8170 33RD AVE S, MS21110Q, MINNEAPOLIS, MN 55425-4516
(952) 883-5375
(952) 883-5395
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R165885-9
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
51915560
—
MN
Enumeration date
08/12/2005
Last updated
12/05/2011
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