AMY LYNN LISDAHL (NPI# 1700123973) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1700123973 |
Entity Type | Individual |
Full Name | AMY LYNN LISDAHL |
Credential | PMHNP |
Practice Address |
1500 N 34th St Ste 100 Superior WI 54880-4476 |
Mailing Address |
1401 E 1st St Duluth MN 55805-2407 |
Practice Telephone | 7153928216 |
Practice Fax Number | 7153926055 |
Mailing Telephone | 2187284491 |
Mailing Fax Number | 2187302367 |
Enumeration Date | 2013-01-08 |
Last Update Date | 2020-10-29 |
Gender Code | F |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 163W00000X | Registered Nurse | 606806 | CA | Nursing Service Providers |
N | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
CNP4944 | MN | Physician Assistants & Advanced Practice Nursing Providers |
Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
7410 | WI | Physician Assistants & Advanced Practice Nursing Providers |
N | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
95002695 | CA | Physician Assistants & Advanced Practice Nursing Providers |
Address | Telephone Number | Fax Number |
---|---|---|
1401 E 1st St, Duluth, MN 558052407 | 2187284491 | 2187302367 |
Street Address |
1500 N 34TH ST STE 100 |
City | SUPERIOR |
State | WI |
Zip Code | 54880-4476 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1407021579 | Human Development Center | Case Management | 1500 N 34th St Ste 100, Superior, WI 54880-4476 | 2008-04-29 |
1700344009 | Emily Weber | Case Manager/Care Coordinator | 1500 N 34th St Ste 100, Superior, WI 54880-4476 | 2019-03-05 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1104427194 | Alana Catherine Sullivan | Speech-Language Pathologist | 25 N 25th Street E, Superior, WI 54880 | 2020-11-05 |
1710524970 | Sean Wiberg Peterson | Specialist/Technologist | 1810 Catlin Ave, Room 1246, Superior, WI 54880 | 2019-12-06 |
1558858936 | Brent Adam Engstrom | Student in an Organized Health Care Education/Training Program | 1410 Nth 23rd Street, Superior, WI 54880 | 2018-04-20 |
1558769125 | David Kroll | Specialist | Balknap & Catlin Aves., Superior, WI 54880 | 2014-12-15 |
1154670321 | Superior Treatment Center, Inc | Community/Behavioral Health | 1507 Tower Ave Ste 307, Superior, WI 54880 | 2012-09-04 |
1548551658 | Dionne Jeannine Corcoran | Midwife | 916 Hammond Ave Ste 222, Superior, WI 54880 | 2011-04-22 |
1821235433 | Lauren Ashley Miller | Speech-Language Pathologist | 35 N. 28th Street, Superior, WI 54880 | 2009-01-20 |
1528261989 | Stacy Ann Kennelly | Physical Therapist | 1612 N 37th Street, Superior, WI 54880 | 2007-06-06 |
1760564942 | James Henry Dobis | Family Medicine | 3520 Tower Avenue, Twin Ports Va Outpatient Clinic, Superior, WI 54880 | 2006-10-19 |
1134214398 | Kevin M Mikel | Dentist | 3312 Tower Avenue, Superior, WI 54880 | 2006-10-04 |
Find all providers in zip 54880 |
Taxonomy Code | 363LP0808X |
Grouping | Physician Assistants & Advanced Practice Nursing Providers |
Classification | Nurse Practitioner |
Specialization | Psych/Mental Health |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1881857167 | Holly Lynn Gomez-levine | Nurse Practitioner | 3500 Tower Ave, Superior, WI 54880-4491 | 2008-07-07 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1003422726 | Wisconsin Healthcare Family Practices and Behavioral Services LLC | Nurse Practitioner | 10721 W Capitol Dr Ste G103, Wauwatosa, WI 53222-1210 | 2020-09-17 |
1689292856 | Julianne Margaret John | Nurse Practitioner | 3237 S 16th St Ste 310, Milwaukee, WI 53215-4526 | 2020-07-13 |
1356968002 | Marisa Hiley | Nurse Practitioner | W129 N7055 Northfield Drive, Menomonee Falls, WI 53051 | 2020-06-29 |
1932726700 | Lauren Marie Skemp | Nurse Practitioner | 1960 Hyview Rd, Cuba City, WI 53807-9718 | 2020-06-28 |
1235779240 | Conscious Practice, LLC | Nurse Practitioner | 119 19th St N, La Crosse, WI 54601-3724 | 2020-01-08 |
1073152161 | Stephanie L Ruskell | Nurse Practitioner | 3805 Spring St Ste 240, Mount Pleasant, WI 53405-1667 | 2020-01-06 |
1558924811 | Sarah Kathryn Garven | Nurse Practitioner | 5000 West National Ave Rm 3119, Milwaukee, WI 53295-1000 | 2019-04-22 |
1104394535 | Therese Ann Alm | Nurse Practitioner | 383 Williamstowne Ste 101, Delafield, WI 53018-2332 | 2018-11-03 |
1477079242 | Aeron Rachel Adams | Nurse Practitioner | W10237 Lake Emily Rd, Fox Lake, WI 53933 | 2017-08-14 |
1396140398 | Monica Gorski | Nurse Practitioner | 505 King St Ste 218, La Crosse, WI 54601-4289 | 2014-11-03 |
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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.