IndividualActive
Lyle Willock, RNFA, PA, ROPA-C
NPI 1972619690 · Clinical Nurse Specialist · Eden Prairie, MN
Provider details
- NPI number
- 1972619690
- Entity type
- Individual
- Primary specialty
- Clinical Nurse SpecialistPhysician Assistants & Advanced Practice Nursing Providers
- Credential
- RNFA, PA, ROPA-C
- Sex
- Male
- Sole proprietor
- Yes
- License
- R0773991 (MN)
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
Practice location
775 Prairie Center Dr
Suite 250
Eden Prairie, MN 55344-7314
Phone: (952) 944-2519
Fax: (952) 944-0460
Approximate (ZIP-level) locationGet directions
Mailing address
6465 Wayzata Blvd
St Louis Park, MN 55426-1728
Registry dates
- Enumerated
- 2006-08-23
- Last updated
- 2007-07-11
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.