Individual
LISA ANN BAUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, CDDN
Contact information
Practice address
6840 78TH AVE N, BROOKLYN PARK, MN 55445-2760
(612) 718-6230
Mailing address
7000 78TH AVE N, BROOKLYN PARK, MN 55445-2744
(612) 718-6230
(763) 416-9120
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
94145611
CA
163W00000X
Registered Nurse
Primary
R146370-1
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2015015
CERTIFICATION DEVELOPMENTAL DISABILITY NURSE - NATIONAL ASSOCIATION
MN
01
—
94145611
NURSING LICENSE
CA
01
—
R146370-1
NURSING LICENSE
MN
Enumeration date
08/01/2018
Last updated
08/01/2018
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