Provider Demographics
NPI:1437134921
Name:LETHLEAN, HELEN M (CNS)
Entity Type:Individual
Prefix:
First Name:HELEN
Middle Name:M
Last Name:LETHLEAN
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 WEST AVE S
Mailing Address - Street 2:
Mailing Address - City:LACROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601
Mailing Address - Country:US
Mailing Address - Phone:608-392-9831
Mailing Address - Fax:608-392-9814
Practice Address - Street 1:800 WEST AVE S
Practice Address - Street 2:
Practice Address - City:LACROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601
Practice Address - Country:US
Practice Address - Phone:608-392-9831
Practice Address - Fax:608-392-9814
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR-176681-9163W00000X
WI90751163W00000X
WI2781364SA2200X, 364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No163W00000XNursing Service ProvidersRegistered Nurse
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN206322100Medicaid
WI31997500Medicaid
WI31997500Medicaid
MN206322100Medicaid
MN890000374Medicare PIN
WI89000338Medicare PIN