Provider Demographics
NPI:1750534582
Name:TRUONG, LENA W (PA-C)
Entity type:Individual
Prefix:
First Name:LENA
Middle Name:W
Last Name:TRUONG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2104 NORTHDALE BLVD NW
Mailing Address - Street 2:SUITE 220
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-3028
Mailing Address - Country:US
Mailing Address - Phone:763-537-6000
Mailing Address - Fax:763-537-6666
Practice Address - Street 1:2104 NORTHDALE BLVD NW
Practice Address - Street 2:SUITE 220
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55433-3028
Practice Address - Country:US
Practice Address - Phone:763-537-6000
Practice Address - Fax:763-537-6666
Is Sole Proprietor?:No
Enumeration Date:2008-10-24
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10522363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant