Provider Demographics
NPI:1447325170
Name:NUTTER, LISA J (APNP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:J
Last Name:NUTTER
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:MRS
Other - First Name:LISA
Other - Middle Name:JOHNSON
Other - Last Name:NUTTER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1836 SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-5429
Mailing Address - Country:US
Mailing Address - Phone:608-782-7300
Mailing Address - Fax:
Practice Address - Street 1:226 N 2ND ST
Practice Address - Street 2:
Practice Address - City:LA CRESCENT
Practice Address - State:MN
Practice Address - Zip Code:55947-1111
Practice Address - Country:US
Practice Address - Phone:507-895-6610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1236242363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN658023800Medicaid
S28574Medicare UPIN
MN500000195Medicare ID - Type Unspecified