Provider Demographics
NPI:1295837144
Name:LORNTSON, REENA PATEL (WHNP)
Entity Type:Individual
Prefix:
First Name:REENA
Middle Name:PATEL
Last Name:LORNTSON
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6401 UNIVERSITY AVE NE
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-4341
Mailing Address - Country:US
Mailing Address - Phone:763-572-5710
Mailing Address - Fax:763-571-3008
Practice Address - Street 1:13819 HANSON BLVD NW
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MN
Practice Address - Zip Code:55304-7608
Practice Address - Country:US
Practice Address - Phone:763-572-5710
Practice Address - Fax:763-862-4490
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR168252-4363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN005853000Medicaid
MN1046227OtherPREFERRED ONE
MN2422246OtherAMERICA'S PPO
MN0704668OtherMEDICA
MN182473OtherUCARE MN
MN733T3PAOtherBCBS OF MN
MN182473OtherUCARE MN
MN2422246OtherAMERICA'S PPO