Individual
MS. LISA RAE HENNEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN, CNP
Contact information
Practice address
720 4TH AVE S, SAINT CLOUD, MN 56301-4498
(320) 308-3191
(320) 308-3192
Mailing address
720 4TH AVE S, SAINT CLOUD, MN 56301-4442
(320) 308-3191
(320) 308-3192
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
2121
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
862953600
—
MN
01
—
P00221874
RR MEDICARE
MN
Enumeration date
01/18/2006
Last updated
07/16/2024
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