Provider Demographics
NPI:1205820719
Name:STEGNER, LESA RENAE (MSN)
Entity Type:Individual
Prefix:
First Name:LESA
Middle Name:RENAE
Last Name:STEGNER
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:LESA
Other - Middle Name:RENAE
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN
Mailing Address - Street 1:22542 HAYWARD AVE N
Mailing Address - Street 2:
Mailing Address - City:FOREST LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55025-8560
Mailing Address - Country:US
Mailing Address - Phone:651-398-5517
Mailing Address - Fax:
Practice Address - Street 1:900 NICOLLET MALL
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-2530
Practice Address - Country:US
Practice Address - Phone:612-659-7111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1411766363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN500002896Medicare PIN
Q00953Medicare UPIN
500002896Medicare ID - Type Unspecified