| Doctor Name: | LYLE DAVID WILLOCK |
| NPI Number: | 1972619690 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | RNFA, PA, ROPA-C |
| License Number: | R0773991 |
| Business Practice Address: | 775 Prairie Center Dr Suite 250 Eden Prairie, MN - 553447314 |
| Business Phone Number: | 9529442519 |
| Business Fax Number: | 9529440460 |
| Mailing Address: | 6465 Wayzata Blvd, Suite 900 ST LOUIS PARK |
| State: | MN |
| Postal Code: | 554261728 |
| Phone Number: | 9525125600 |
| Fax Number: | 9525125650 |
| NPI Enumeration Date: | 08/23/2006 |
| NPI Last Update Date: | 07/11/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 364S00000X |
| License Number: | R0773991 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Clinical Nurse Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A registered nurse who, through a graduate degree program in nursing, or through a formal post-basic education program or continuing education courses and clinical experience, is expert in a specialty area of nursing practice within one or more of the components of direct patient/client care, consultation, education, research and administration. |