MEDICARE: RACHEL ELIZABETH LENZ PA-C

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	363A00000X	Physician Assistant	15386	MN
2	363A00000X	Physician Assistant	8476-23	WI

General Provider Information

NPI Number	:	1629964978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RACHEL ELIZABETH LENZ PA-C

Provider Business Mailing Address
First Line	:	2720 FAIRVIEW AVE N STE 200
Second Line	:
City	:	ROSEVILLE
State	:	MN
Zip	:	55113-1306
Country	:	US
Telephone Number	:	651-633-6883
Fax Number	:	651-331-3459

Provider Business Practice Location Address
First Line	:	2720 FAIRVIEW AVE N STE 200
Second Line	:
City	:	ROSEVILLE
State	:	MN
Zip	:	55113-1306
Country	:	US
Telephone Number	:	651-633-6883
Fax Number	:

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

Provider Enumeration Date	:	06/14/2025
Last Update Date	:	05/14/2026

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