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Lyle David Willock, RNFA,PA,ROPA-C
Clinical Nurse Specialist in Eden Prairie, Minnesota
NPI 1972619690

Lyle David Willock is a Clinical Nurse Specialist based in St Louis Park, MN. Lyle David Willock practices in Eden Prairie, MN and has the professional credentials of RNFA,PA,ROPA-C. The NPI Number for Lyle David Willock is 1972619690 and holds a License No. R0773991 (Minnesota).

The current practice location address for Lyle David Willock is 775 Prairie Center Dr, Eden Prairie, MN and can be reached out via phone at 952-944-2519 and via fax at 952-944-0460.

Location: 775 Prairie Center Dr, Eden Prairie, MN, 55426-1728
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1972619690
Provider Name
Lyle David Willock
Credential
RNFA,PA,ROPA-C
Provider Entity Type
Individual
Gender
Male
Address
775 Prairie Center Dr, Eden Prairie, MN, 55426-1728
Phone Number
952-944-2519
Fax Number
952-944-0460
Provider Enumeration Date
08/23/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
969991011727 01 PREFERREDONE
73B62WI 01 BLUECROSS BLUESHIELD
HP43945 01 HEALTHPARTNERS
institution
Provider Business Practice Location Address Details
Address
775 Prairie Center Dr
City
Eden Prairie
State
Minnesota
Zip
55344-7314
Phone Number
952-944-2519
Fax Number
952-944-0460
person
Provider Business Mailing Address Details
Address
775 Prairie Center Dr
City
Eden Prairie
State
Minnesota
Zip
55344-7314
Phone Number
952-944-2519
Fax Number
952-944-0460
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Clinical Nurse Specialist
Speciality
-
Taxonomy
364S00000X
License No.
R0773991 (Minnesota)
Definition
A registered nurse who, through a graduate degree program in nursing, or through a formal post-basic education program or continuing education courses and clinical experience, is expert in a specialty area of nursing practice within one or more of the components of direct patient/client care, consultation, education, research and administration.
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