Provider Demographics
NPI:1285919548
Name:OCKER, LISA RENEE (FNP/PMHNP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:RENEE
Last Name:OCKER
Suffix:
Gender:F
Credentials:FNP/PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 196TH LN NW
Mailing Address - Street 2:
Mailing Address - City:OAK GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55011-4437
Mailing Address - Country:US
Mailing Address - Phone:763-913-1042
Mailing Address - Fax:
Practice Address - Street 1:1525 196TH LN NW
Practice Address - Street 2:
Practice Address - City:OAK GROVE
Practice Address - State:MN
Practice Address - Zip Code:55011-4437
Practice Address - Country:US
Practice Address - Phone:763-913-1042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-19
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR161143-0363LF0000X, 363LP0808X
MN1226363LP0808X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health