Provider Demographics
NPI:1063482941
Name:BRATSCH-MONTAG, LISA (WHCNP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:BRATSCH-MONTAG
Suffix:
Gender:F
Credentials:WHCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1517 SQUIRRELS NEST RD
Mailing Address - Street 2:
Mailing Address - City:KASOTA
Mailing Address - State:MN
Mailing Address - Zip Code:56050-9614
Mailing Address - Country:US
Mailing Address - Phone:507-243-4193
Mailing Address - Fax:
Practice Address - Street 1:310 BELLE AVE
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-5287
Practice Address - Country:US
Practice Address - Phone:507-387-5581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1203880363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
28381OtherSIOUX VALLEY HEALTH PLAN
124880OtherUCARE
HP26547OtherHEALTH PARTNERS
07-00864OtherMEDICA
MN240596200Medicaid
1022664OtherPREFERRED ONE
1067918OtherAMERICA'S PPO (ARAZ)
MN68G15CLOtherBCBS MN
MN240596200Medicaid
P56783Medicare UPIN