Healthcare Provider Details

I. General information

NPI: 1962649517
Provider Name (Legal Business Name): JASON LENZO PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2009
Last Update Date: 01/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 UNIVERSITY AVE W SUITE 200
SAINT PAUL MN
55104-3453
US

IV. Provider business mailing address

1919 UNIVERSITY AVE W SUITE 200
SAINT PAUL MN
55104-3453
US

V. Phone/Fax

Practice location:
  • Phone: 651-266-7999
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2008009912
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: