Provider Demographics
NPI:1114598109
Name:FRENTZEL, STEPHANIE LEANNE (PA)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LEANNE
Last Name:FRENTZEL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 100TH ST SE
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:MN
Mailing Address - Zip Code:56215-2455
Mailing Address - Country:US
Mailing Address - Phone:320-226-9433
Mailing Address - Fax:
Practice Address - Street 1:215 100TH ST SE
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:MN
Practice Address - Zip Code:56215-2455
Practice Address - Country:US
Practice Address - Phone:320-226-9433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-09
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant