Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Lisa N Von Wald, AGPCNP-BC

Individual provider Registered Nurse · NPI 1093147142

Lisa N Von Wald, AGPCNP-BC is a Nurse Practitioner in Minneapolis, Minnesota. Qualified in 2013, 13 years ago. Practices with Grand Itasca Clinic and Hospital, a 325-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Minnesota.

Years since qualifying
13
Licensed in
MN
In the registry since
2013
Specialties on file
2
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Practice location Address checks out

500 Harvard St SE
Minneapolis, MN 55455-0363
Phone: (612) 273-3000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Nurse Practitioner (primary) Taxonomy 363L00000X · Licence 2013006750 (MN)
Registered Nurse Taxonomy 163W00000X · Licence R179726-0 (MN)

Record details

NPI number1093147142
Entity typeIndividual (Type 1)
GenderFemale
Credentials AGPCNP-BC
Sole proprietorYes
NPI enumeratedJuly 31, 2013
Last updated in NPPESAugust 8, 2013

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2013 (13 years in practice)
Group practice Grand Itasca Clinic And Hospital — 325 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations8 on file with Medicare

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