Healthcare Provider Details

I. General information

NPI: 1538573449
Provider Name (Legal Business Name): REBECCA ANNE LENZ APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BECCA ANNE LENZ

II. Dates (important events)

Enumeration Date: 06/18/2014
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 UNIVERSITY AVE W STE 100
SAINT PAUL MN
55104-3727
US

IV. Provider business mailing address

1023 LINWOOD AVE APT 4
SAINT PAUL MN
55105-3282
US

V. Phone/Fax

Practice location:
  • Phone: 952-924-8117
  • Fax: 651-326-9635
Mailing address:
  • Phone: 651-366-0336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number185841-3
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2699
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number2699
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: