Provider Demographics
NPI:1619497476
Name:LENZ, LAURA I (FNP)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:I
Last Name:LENZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5221 PORTLAND AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55417-1721
Mailing Address - Country:US
Mailing Address - Phone:612-267-5924
Mailing Address - Fax:952-912-3553
Practice Address - Street 1:415 17TH AVE N
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55343-7224
Practice Address - Country:US
Practice Address - Phone:952-912-3553
Practice Address - Fax:952-912-3553
Is Sole Proprietor?:No
Enumeration Date:2017-06-22
Last Update Date:2024-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1913808363LF0000X
MN2017009107363LF0000X
MNCNP5215363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily