Provider Demographics
NPI:1265869606
Name:TIEU, LISA THANH (DNP, CNP)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:THANH
Last Name:TIEU
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Gender:F
Credentials:DNP, CNP
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Mailing Address - Street 1:9700 WATERSTONE PL
Mailing Address - Street 2:APT 208A
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55305-5539
Mailing Address - Country:US
Mailing Address - Phone:612-803-7618
Mailing Address - Fax:
Practice Address - Street 1:5100 GAMBLE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-1521
Practice Address - Country:US
Practice Address - Phone:952-541-2500
Practice Address - Fax:952-541-2539
Is Sole Proprietor?:No
Enumeration Date:2013-10-01
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN215505-0363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily