Provider Demographics
NPI:1922096767
Name:BAKANOWSKI, RACHEL LESLEY (APRN-BC)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:LESLEY
Last Name:BAKANOWSKI
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:MS
Other - First Name:RACHEL
Other - Middle Name:LESLEY
Other - Last Name:SENSEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:HENNEPIN HEALTHCARE EAST LAKE CLINIC
Mailing Address - Street 2:2700 EAST LAKE ST. #1100
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406
Mailing Address - Country:US
Mailing Address - Phone:612-873-6963
Mailing Address - Fax:612-276-0188
Practice Address - Street 1:HENNEPIN HEALTHCARE EAST LAKE CLINIC
Practice Address - Street 2:2700 EAST LAKE ST. #1100
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406
Practice Address - Country:US
Practice Address - Phone:612-873-6963
Practice Address - Fax:612-276-0188
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN208604-8163W00000X
VA0024167030363LF0000X
MNCNP1533363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
P73119Medicare UPIN