Provider Demographics
NPI:1013547850
Name:POLK, LEXIE FRANCES (CNP)
Entity Type:Individual
Prefix:
First Name:LEXIE
Middle Name:FRANCES
Last Name:POLK
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3520 N SHORE DR
Mailing Address - Street 2:
Mailing Address - City:WAYZATA
Mailing Address - State:MN
Mailing Address - Zip Code:55391-9360
Mailing Address - Country:US
Mailing Address - Phone:218-851-8923
Mailing Address - Fax:
Practice Address - Street 1:991 SIBLEY MEMORIAL HWY STE 100
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55118-5114
Practice Address - Country:US
Practice Address - Phone:651-379-3110
Practice Address - Fax:651-379-3111
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-21
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7081363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Single Specialty