MEDICARE: MRS. DONNA LYNN LENNES RN, CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	R114108-1	MN

General Provider Information

NPI Number	:	1326471178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DONNA LYNN LENNES RN, CNP

Provider Business Mailing Address
First Line	:	2330 CENTRAL AVE NE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55418-3710
Country	:	US
Telephone Number	:	612-781-1212
Fax Number	:	612-781-5251

Provider Business Practice Location Address
First Line	:	2330 CENTRAL AVE NE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55418-3710
Country	:	US
Telephone Number	:	612-781-1212
Fax Number	:	612-781-5251

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2013
Last Update Date	:	08/15/2013

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