Provider Demographics
NPI:1700123973
Name:LISDAHL, AMY LYNN (PMHNP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN
Last Name:LISDAHL
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1900 SILVER LAKE RD NW
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112-1786
Mailing Address - Country:US
Mailing Address - Phone:651-628-9566
Mailing Address - Fax:651-628-0411
Practice Address - Street 1:810 E 4TH ST
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-2147
Practice Address - Country:US
Practice Address - Phone:218-728-4491
Practice Address - Fax:218-730-2367
Is Sole Proprietor?:No
Enumeration Date:2013-01-08
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA606806163W00000X
MNCNP4944363LP0808X
CA95002695363LP0808X
WI7410363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse