Provider Demographics
NPI:1063194041
Name:YSEN, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:YSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1607 7TH AVE E
Mailing Address - Street 2:
Mailing Address - City:INTERNATIONAL FALLS
Mailing Address - State:MN
Mailing Address - Zip Code:56649-3024
Mailing Address - Country:US
Mailing Address - Phone:218-290-8533
Mailing Address - Fax:218-283-9694
Practice Address - Street 1:621 3RD AVE
Practice Address - Street 2:
Practice Address - City:INTERNATIONAL FALLS
Practice Address - State:MN
Practice Address - Zip Code:56649-2637
Practice Address - Country:US
Practice Address - Phone:218-283-2525
Practice Address - Fax:218-283-9694
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier