Provider Demographics
NPI:1497862890
Name:BYRNE, LISA WILDKNITS (RN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:WILDKNITS
Last Name:BYRNE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:B
Other - Last Name:MESSERER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1000 E 1ST ST STE LL
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-2297
Mailing Address - Country:US
Mailing Address - Phone:218-249-3852
Mailing Address - Fax:218-249-6231
Practice Address - Street 1:1000 E 1ST ST STE LL
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-2297
Practice Address - Country:US
Practice Address - Phone:218-249-3852
Practice Address - Fax:218-249-6231
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2025-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704413688163W00000X
MN174068-6163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI155531OtherLICENSE
MN174068-6OtherLICENSE