Provider Demographics
NPI:1538573449
Name:LENZ, REBECCA ANNE (APRN)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANNE
Last Name:LENZ
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:BECCA
Other - Middle Name:ANNE
Other - Last Name:LENZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1023 LINWOOD AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-3282
Mailing Address - Country:US
Mailing Address - Phone:651-366-0336
Mailing Address - Fax:
Practice Address - Street 1:1700 UNIVERSITY AVE W STE 100
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-3727
Practice Address - Country:US
Practice Address - Phone:952-924-8117
Practice Address - Fax:651-326-9635
Is Sole Proprietor?:No
Enumeration Date:2014-06-18
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN185841-3363LG0600X
MN2699363LP0808X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health