MRS. LISA BORDEAUX (NPI# 1376586792) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376586792 |
| Entity Type | Individual |
| Full Name | MRS. LISA BORDEAUX |
| Credential | CNP |
| Practice Address |
4040 Coon Rapids Blvd Nw Suite 120 Minneapolis MN 55433-2522 |
| Practice Telephone | 7634279980 |
| Practice Fax Number | 7634279908 |
| Mailing Telephone | 7634279980 |
| Mailing Fax Number | 7634279908 |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2019-06-17 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363L00000X | Nurse Practitioner | 3228 | MN | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363L00000X | Nurse Practitioner | R1222515 | MN | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | 771170100 | 05 |
| Street Address |
4040 COON RAPIDS BLVD NW SUITE 120 |
| City | MINNEAPOLIS |
| State | MN |
| Zip Code | 55433-2522 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932189966 | Zaur Mirzoyev | Internal Medicine | 4040 Coon Rapids Blvd Nw, Minneapolis, MN 55433-4567 | 2006-01-17 |
| 1568913622 | Jeffrey Otto | Physician Assistant | 4040 Coon Rapids Blvd Nw, Suite 120, Minneapolis, MN 55433-4567 | 2016-10-24 |
| 1649600438 | Ashley Harrison Konstantinides | Physician Assistant | 4040 Coon Rapids Blvd Nw, Suite 120, Minneapolis, MN 55433-4567 | 2013-11-15 |
| 1366485724 | Elizabeth A Hoffman | Physician Assistant | 4040 Coon Rapids Blvd Nw, Suite 120, Minneapolis, MN 55433-2522 | 2006-06-14 |
| 1568405488 | Paul Finstad | Physician Assistant | 4040 Coon Rapids Blvd Nw, Suite 120, Minneapolis, MN 55433-2522 | 2006-06-14 |
| 1912940339 | Susan D Roseberg | Nurse Practitioner | 4040 Coon Rapids Blvd Nw, Suite 120, Minneapolis, MN 55433-2522 | 2006-06-14 |
| 1437192598 | Jeffrey Chambers | Internal Medicine | 4040 Coon Rapids Blvd Nw, Suite 120, Minneapolis, MN 55433-4567 | 2006-06-14 |
| 1184667248 | Joseph Lin | Internal Medicine | 4040 Coon Rapids Blvd Nw, Suite 120, Minneapolis, MN 55433-4567 | 2006-06-14 |
| 1073556593 | Randall P Stark | Internal Medicine | 4040 Coon Rapids Blvd Nw, Suite 120, Minneapolis, MN 55433-2522 | 2006-06-13 |
| 1144263674 | Brian J Anderson | Internal Medicine | 4040 Coon Rapids Blvd Nw, Suite 120, Minneapolis, MN 55433-2522 | 2006-06-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770134793 | Shelley Karee Peterson | Technician | 10311 Bittersweet St Nw, Coon Rapids, MN 55433 | 2019-09-20 |
| 1578122057 | Courtney Gau | Behavior Technician | Fraser Coon Rapids, 9120 Springbrook Dr. Nw, Coon Rapids, MN 55433 | 2019-06-10 |
| 1992275606 | Maliki Fofee Kamara | Licensed Practical Nurse | 2451 109th Ave Nw Apt. 1, Coon Rapids, MN 55433 | 2018-11-26 |
| 1992284541 | Sarah Vennes | Massage Therapist | 6400 Flying Cloud Dr, Suite 240, Eden Prairie, MN 55433 | 2018-08-13 |
| 1538646609 | Paige Prince | Behavior Technician | Fraser Coon Rapids, 9120 Springbrook Drive Nw, Coon Rapids, MN 55433 | 2018-07-23 |
| 1154828242 | Karin Lea Englund | Dentist | 9145 Springbrook Dr Nw Ste 100, Coon Rapids, MN 55433 | 2018-04-06 |
| 1235642513 | Vista Family Eye Care LLC | Optometrist | 9920 Foley Blvd Nw Ste 120, Coon Rapids, MN 55433 | 2017-11-09 |
| 1538697818 | Mohammed Nmn Ahmed | Internal Medicine | 9055 Spring Brook Drive, Allina Coon Rapids Clinic 9055, Coon Rapids, MN 55433 | 2017-05-31 |
| 1639531353 | Journi LLC | Nurse Practitioner | 277 Coon Rapids Blvd Suite 308, Coon Rapids, MN 55433 | 2016-03-22 |
| 1821457722 | Honorine Boyce | Licensed Practical Nurse | 2743 111th Ave. Nw, Coon Rapids, MN 55433 | 2016-02-19 |
| Find all providers in zip 55433 | ||||
| Taxonomy Code | 363L00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. |
| Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841803970 | Kelsey Olson | Nurse Practitioner | 2450 Riverside Ave Fl 9, Minneapolis, MN 55454-1450 | 2020-08-28 |
| 1396373932 | Hayley Starr Gifford | Nurse Practitioner | 33 105th Ave Nw, Minneapolis, MN 55448-5044 | 2020-03-30 |
| 1225535701 | Karissa Dougherty | Nurse Practitioner | 2200 E Franklin Ave # 199, Minneapolis, MN 55404 | 2018-04-10 |
| 1831646108 | Ingrid Estephan | Nurse Practitioner | 2929 21st Ave S Apt 301, Minneapolis, MN 55407-4515 | 2016-09-05 |
| 1730532631 | Allina Health System | Nurse Practitioner | 913 E 26th St Ste 305, Minneapolis, MN 55404-4515 | 2016-07-15 |
| 1619376860 | Amy Cooley | Nurse Practitioner | 800 E 28th St # H2100, Minneapolis, MN 55407 | 2014-08-13 |
| 1710265368 | Kimberly Dawn Moore | Nurse Practitioner | 814 South 3rd Street, Minneapolis, MN 55415 | 2011-08-01 |
| 1164700878 | Katherine Casey Martin Caughel | Nurse Practitioner | Hcmc, 701 Park Ave, Surgery Department, P-5, Minneapolis, MN 55415-1623 | 2011-07-29 |
| 1386951358 | Jody Michelle Schoenecker | Nurse Practitioner | 615 1st Ave Ne Ste 310, Minneapolis, MN 55413-2419 | 2010-09-10 |
| 1043543093 | Therese Mary Maas | Nurse Practitioner | 909 Fulton St Se Ste 300, Minneapolis, MN 55455 | 2009-09-09 |
| Find all providers in MINNEAPOLIS | ||||
| City | MINNEAPOLIS |
| Zip Code | 55433 |
Please comment or provide details below to improve the information on MRS. LISA BORDEAUX.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.