Provider Demographics
NPI:1568262731
Name:THOMAS, LISA LUCILLE (RN, CFCN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:LUCILLE
Last Name:THOMAS
Suffix:
Gender:
Credentials:RN, CFCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4603 MINNEHAHA AVE UNIT 420
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-4271
Mailing Address - Country:US
Mailing Address - Phone:763-288-9059
Mailing Address - Fax:
Practice Address - Street 1:4603 MINNEHAHA AVE UNIT 420
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406-4271
Practice Address - Country:US
Practice Address - Phone:763-288-9059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2412861163WW0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0000XNursing Service ProvidersRegistered NurseWound Care