Provider Demographics
NPI:1003426230
Name:LEJONVARN, SEAN DEANE (CNP)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:DEANE
Last Name:LEJONVARN
Suffix:
Gender:
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 W LAKE ST
Mailing Address - Street 2:
Mailing Address - City:WACONIA
Mailing Address - State:MN
Mailing Address - Zip Code:55387-1014
Mailing Address - Country:US
Mailing Address - Phone:651-603-4565
Mailing Address - Fax:833-630-0621
Practice Address - Street 1:212 W LAKE ST
Practice Address - Street 2:
Practice Address - City:WACONIA
Practice Address - State:MN
Practice Address - Zip Code:55387-1014
Practice Address - Country:US
Practice Address - Phone:763-232-1209
Practice Address - Fax:833-630-0621
Is Sole Proprietor?:No
Enumeration Date:2020-08-03
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7663363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN-Medicaid