Provider Demographics
NPI:1023023561
Name:RUPP, LORNA LEE (RN, CNP)
Entity Type:Individual
Prefix:
First Name:LORNA
Middle Name:LEE
Last Name:RUPP
Suffix:
Gender:F
Credentials:RN, CNP
Other - Prefix:
Other - First Name:LORNA
Other - Middle Name:LEE
Other - Last Name:WILBRECHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5775 WAYZATA BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55416-1227
Mailing Address - Country:US
Mailing Address - Phone:952-525-4511
Mailing Address - Fax:952-525-1560
Practice Address - Street 1:5775 WAYZATA BLVD STE 200
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55416-1227
Practice Address - Country:US
Practice Address - Phone:952-525-4511
Practice Address - Fax:952-525-1560
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 153391-6363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN856463900Medicaid
11046424OtherPREFERRED ONE
41-1677590OtherWEA TRUST
733T5UROtherBLUE CROSS BLUE SHIELD
ND10088Medicaid
41-1677590Other1ST CHOICE OF THE MIDWEST
2418100OtherAMERICAS PPO
HP58497OtherHEALTHPARTNERS
733T5UROtherBLUE CROSS BLUE SHIELD
41-1677590OtherWEA TRUST