Individual
LISA BERNTSON DORNICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP
Contact information
Practice address
250 S 4TH ST, MINNEAPOLIS, MN 55415-1384
(612) 673-2301
(612) 673-3866
Mailing address
250 S 4TH ST, ROOM 250, MINNEAPOLIS, MN 55415-1384
(612) 673-2301
(612) 673-3866
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
R-101808-8
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
782314200
—
MN
Enumeration date
06/03/2006
Last updated
09/21/2012
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