Basic Information
| Provider Information | |||||||||
| NPI: | 1265869606 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TIEU | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | THANH | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DNP, CNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9700 WATERSTONE PL | ||||||||
| Address2: | APT 208A | ||||||||
| City: | MINNETONKA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553055539 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6128037618 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5100 GAMBLE DR | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | ST LOUIS PARK | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554161521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9525412500 | ||||||||
| FaxNumber: | 9525412539 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/01/2013 | ||||||||
| LastUpdateDate: | 09/12/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 215505-0 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.