Provider Demographics
NPI:1134393135
Name:FROLEK, LENAE R (CRNA)
Entity type:Individual
Prefix:
First Name:LENAE
Middle Name:R
Last Name:FROLEK
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:LENAE
Other - Middle Name:R
Other - Last Name:SELCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1720 UNIVERSITY DR S RT 1707
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-4940
Mailing Address - Country:US
Mailing Address - Phone:701-234-6259
Mailing Address - Fax:
Practice Address - Street 1:1720 UNIVERSITY DR S RT 1707
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-4940
Practice Address - Country:US
Practice Address - Phone:701-234-6259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-22
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAD119298367500000X
NDR39877367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1134393135Medicaid
IAP00623364OtherRR MEDICARE
ND17543Medicaid
IAP00623364OtherRR MEDICARE
ND17543Medicaid
NDN719472Medicare PIN