Healthcare Provider Details

I. General information

NPI: 1134393135
Provider Name (Legal Business Name): LENAE R FROLEK CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LENAE R SELCH

II. Dates (important events)

Enumeration Date: 04/22/2008
Last Update Date: 07/08/2021
Certification Date: 07/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 UNIVERSITY DR S RT 1707
FARGO ND
58103-4940
US

IV. Provider business mailing address

1720 UNIVERSITY DR S RT 1707
FARGO ND
58103-4940
US

V. Phone/Fax

Practice location:
  • Phone: 701-234-6259
  • Fax:
Mailing address:
  • Phone: 701-234-6259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberD119298
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR39877
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: