NPIMap

Individual provider Active NPI

Sean Deane Lejonvarn, CNP

  • Family Nurse Practitioner
  • Waconia, MN
National Provider Identifier
1003426230
Registry record updated Apr 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
7663 Issued in MN
Practice address
212 W Lake St
Waconia, MN 55387-1014
Phone
(763) 232-1209
Fax
(833) 630-0621
NPI assigned
Aug 3, 2020
Last updated
Apr 29, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 7663 MN Primary

Addresses

Primary practice location

212 W Lake St
Waconia, MN 55387-1014

Mailing address

212 W Lake St
Waconia, MN 55387-1014
Phone (651) 603-4565

Other identifiers 1

IdentifierTypeStateIssuer
-MedicaidMN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201005000451 MN Practitioner - Nurse Practitioner 6305265760 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Northern Lights Health LLCGroup PAC ID 6305278797, 11 clinicians

Practice addresses (Care Compare)

212 W Lake St
Waconia, MN 55387-1014
Phone (651) 603-4565

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.79 of 100Reported as group
Quality
95.08
Improvement activities
40
Cost
81.67

Merit-based Incentive Payment System (MIPS)

Final score
97.69 of 100Reported as group
Quality
91.97
Improvement activities
40
Cost
69.67

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
7663MNMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Infinite Health Collaborative, PA CurrentSince Sep 1, 2020 Accepting new patients
Northern Lights Health LLC Family CurrentSince Jun 1, 2023 Accepting new patients
Infinite Health Collaborative, PA CurrentSince Sep 1, 2020 Accepting new patients
Waterside Healthcare & Wellness, LLC Family CurrentSince Jun 1, 2023 Accepting new patients

Locations

1200 Chaska Creek Way
Ste 200
Chaska, MN 55318
Phone (952) 856-1046

920 E 28th St
Ste 440
Minneapolis, MN 55407
Phone (612) 863-5155

204 Lewis Ave S
Watertown, MN 55388
Phone (952) 955-1963

204 Lewis Ave S
Ste 210
Watertown, MN 55388

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1596412800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745884800000",
    "number": "1003426230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "212 W LAKE ST",
            "city": "WACONIA",
            "state": "MN",
            "postal_code": "553871014",
            "telephone_number": "651-603-4565",
            "fax_number": "833-630-0621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "212 W LAKE ST",
            "city": "WACONIA",
            "state": "MN",
            "postal_code": "553871014",
            "telephone_number": "763-232-1209",
            "fax_number": "833-630-0621"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEJONVARN",
        "first_name": "SEAN",
        "middle_name": "DEANE",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-08-03",
        "last_updated": "2025-04-29",
        "certification_date": "2025-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "7663",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "-",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waconia, MN

Sources for this page

Verify at the official NPI Registry.