Provider Demographics
NPI:1043687627
Name:MILBRANDT, LISA RAE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:RAE
Last Name:MILBRANDT
Suffix:
Gender:F
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:1680 DIAGONAL RD
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:56187-1008
Mailing Address - Country:US
Mailing Address - Phone:507-360-8825
Mailing Address - Fax:
Practice Address - Street 1:1680 DIAGONAL RD
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:MN
Practice Address - Zip Code:56187-1008
Practice Address - Country:US
Practice Address - Phone:507-360-8825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-30
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant