Healthcare Provider Details

I. General information

NPI: 1205820719
Provider Name (Legal Business Name): LESA RENAE STEGNER MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LESA RENAE THOMPSON MSN

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 01/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 NICOLLET MALL
MINNEAPOLIS MN
55403-2530
US

IV. Provider business mailing address

22542 HAYWARD AVE N
FOREST LAKE MN
55025-8560
US

V. Phone/Fax

Practice location:
  • Phone: 612-659-7111
  • Fax:
Mailing address:
  • Phone: 651-398-5517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR1411766
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: