Provider Demographics
NPI:1508462813
Name:STENSETH, BREANNE NICOLE (CNP)
Entity Type:Individual
Prefix:
First Name:BREANNE
Middle Name:NICOLE
Last Name:STENSETH
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:BREANNE
Other - Middle Name:NICOLE
Other - Last Name:FACKLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7801 E BUSH LAKE RD
Mailing Address - Street 2:STE 400
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55439-3113
Mailing Address - Country:US
Mailing Address - Phone:952-479-4261
Mailing Address - Fax:866-691-8423
Practice Address - Street 1:7801 E BUSH LAKE RD STE 400
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55439-3113
Practice Address - Country:US
Practice Address - Phone:612-209-9622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-10
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7379363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner