Individual
REBECCA J LIETZOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1540 LAKE ST S, FOREST LAKE, MN 55025-2628
(651) 464-7100
(651) 241-1515
Mailing address
2925 CHICAGO AVE, MINNEAPOLIS, MN 55407-1321
(612) 262-7374
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
141323
WI
163WC0200X
Critical Care Medicine Registered Nurse
R-168269-2
MN
363LA2200X
Adult Health Nurse Practitioner
Primary
4164
MN
363LF0000X
Family Nurse Practitioner
6572
WI
Other
Enumeration date
04/22/2011
Last updated
12/08/2023
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