MEDICARE: MRS. RACHEL LESLEY BAKANOWSKI APRN-BC

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	163W00000X	Registered Nurse	208604-8	MN
2	363LF0000X	Family Nurse Practitioner	0024167030	VA
3	363LF0000X	Family Nurse Practitioner	CNP1533	MN

General Provider Information

NPI Number	:	1922096767
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RACHEL LESLEY BAKANOWSKI APRN-BC

Provider Business Mailing Address
First Line	:	HENNEPIN HEALTHCARE EAST LAKE CLINIC
Second Line	:	2700 EAST LAKE ST. #1100
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55406
Country	:	US
Telephone Number	:	612-873-6963
Fax Number	:	612-276-0188

Provider Business Practice Location Address
First Line	:	HENNEPIN HEALTHCARE EAST LAKE CLINIC
Second Line	:	2700 EAST LAKE ST. #1100
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55406
Country	:	US
Telephone Number	:	612-873-6963
Fax Number	:	612-276-0188

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

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	11/28/2018

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