Doctor Name: | LISA MARIE ZALLAR |
NPI Number: | 1831381193 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CNP |
License Number: | R 160567-9 |
Business Practice Address: | 513 5th Ave W Grand Marais, MN - 556043017 |
Business Phone Number: | 2183872330 |
Business Fax Number: | 2183871278 |
Mailing Address: | 513 5th Ave W, GRAND MARAIS |
State: | MN |
Postal Code: | 556043017 |
Phone Number: | 2183872330 |
Fax Number: | 2183871278 |
NPI Enumeration Date: | 08/10/2007 |
NPI Last Update Date: | 01/24/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | R 160567-9 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |