Basic Information
Provider Information
NPI: 1548672785
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HENSEL
FirstName: LAURIE
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: RN, CNP
OtherOrganizationName:  
OtherOrganizationType:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2925 CHICAGO AVE
Address2:  
City: MINNEAPOLIS
State: MN
PostalCode: 554071321
CountryCode: US
TelephoneNumber: 6122625000
FaxNumber:  
Practice Location
Address1: 1617 E DIVISION ST
Address2:  
City: RIVER FALLS
State: WI
PostalCode: 540221571
CountryCode: US
TelephoneNumber: 7153076600
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/22/2014
LastUpdateDate: 03/11/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
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AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
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AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/11/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XR152211-8MNY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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