Basic Information
| Provider Information | |||||||||
| NPI: | 1184733545 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LYRENMANN | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | JAMES | ||||||||
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| Credential: | OPA-C, RNFA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6465 WAYZATA BLVD | ||||||||
| Address2: | SUITE 900 | ||||||||
| City: | ST LOUIS PARK | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554261728 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9525125600 | ||||||||
| FaxNumber: | 9525125650 | ||||||||
| Practice Location | |||||||||
| Address1: | 7373 FRANCE AVE S | ||||||||
| Address2: | SUITE 312 | ||||||||
| City: | EDINA | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554354534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9528320076 | ||||||||
| FaxNumber: | 9528320477 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 01/15/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SM0705X | R0831237 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Medical-Surgical |
ID Information
| ID | Type | State | Issuer | Description | 969991007207 | 01 | PREFERREDONE | OTHER | HP47971 | 01 | HEALTHPARTNERS | OTHER | 55A74LY | 01 | BLUECROSS BLUESHIELD | OTHER |