Provider Demographics
NPI:1538338603
Name:LA FRENZ, CHARLENE G (NP)
Entity type:Individual
Prefix:
First Name:CHARLENE
Middle Name:G
Last Name:LA FRENZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2210 FOX DR NW
Mailing Address - Street 2:
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-9242
Mailing Address - Country:US
Mailing Address - Phone:218-333-0882
Mailing Address - Fax:
Practice Address - Street 1:1100 38TH ST NW
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-5107
Practice Address - Country:US
Practice Address - Phone:218-751-5430
Practice Address - Fax:218-759-5880
Is Sole Proprietor?:No
Enumeration Date:2008-02-22
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNR154863-9363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN500005933Medicare PIN