Provider Demographics
NPI:1851119713
Name:LISOWSKI, RAMONA L (AGNP-BC)
Entity type:Individual
Prefix:
First Name:RAMONA
Middle Name:L
Last Name:LISOWSKI
Suffix:
Gender:F
Credentials:AGNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2780 SNELLING AVE N STE 304
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-7125
Mailing Address - Country:US
Mailing Address - Phone:651-433-7255
Mailing Address - Fax:651-888-2611
Practice Address - Street 1:2780 SNELLING AVE N STE 304
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-7125
Practice Address - Country:US
Practice Address - Phone:651-433-7255
Practice Address - Fax:651-888-2611
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11365363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily