Lisa Rae Hennen, APRN, CNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

2121 Issued in MN

Practice address

720 4TH Ave S
Saint Cloud, MN 56301-4498

Phone

(320) 308-3191

Fax

(320) 308-3192

NPI assigned

Jan 18, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner, Nurse Practitioner

State licenses

Practice roles

Locations

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

• St Joseph'S Medical Center

  • Multi-Specialty Clinic/Center
  • Staples, MN
  • NPI 1538916101
  NPD
• St. Joseph'S Medical Center

  • General Practice Physician
  • Brainerd, MN
  • NPI 1184866956
  NPD
• St. Joseph'S Medical Center

  • General Acute Care Hospital
  • Brainerd, MN
  • NPI 1568415974
  NPD
• Minnesota State Colleges and Universities

  • Student Health Clinic/Center
  • Saint Cloud, MN
  • NPI 1013993401
  NPD (past)
• Minnesota State Colleges and Universities

  • Clinic/Center
  • Bemidji, MN
  • NPI 1083881452
  NPD (past)

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

{
    "created_epoch": "1137542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721088000000",
    "number": "1588644454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "720 4TH AVE S",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563014442",
            "telephone_number": "320-308-3191",
            "fax_number": "320-308-3192"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "720 4TH AVE S",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563014498",
            "telephone_number": "320-308-3191",
            "fax_number": "320-308-3192"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "610 30th Avenue West",
            "address_2": "Alexandria Clinic",
            "address_purpose": "LOCATION",
            "city": "Alexandria",
            "state": "MN",
            "postal_code": "56308",
            "country_code": "US",
            "telephone_number": "320-763-5123",
            "fax_number": "320-763-7883",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "13060 Isle Dr",
            "address_purpose": "LOCATION",
            "city": "Baxter",
            "state": "MN",
            "postal_code": "564258331",
            "country_code": "US",
            "telephone_number": "218-828-2880",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HENNEN",
        "first_name": "LISA",
        "middle_name": "RAE",
        "name_prefix": "Ms.",
        "credential": "APRN, CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-18",
        "last_updated": "2024-07-16",
        "certification_date": "2024-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "2121",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "862953600",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00221874",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cameron Charles Hendrickson
• Michelle Rae Hengemuhle, LPN
• Coral Henke, LPN
• David Mark Hennen, OTR
• Erin Hennen, M.D.
• Paige Paquette Hennen, FNP-BC
• Theresa Henning, MS
• Sandra S Henschke, CRNA
• Melinda Huber Hensley, CRNA
• Jenna Hentges

• Family Nurse Practitioner in Saint Cloud, MN
• Providers in Saint Cloud, MN by specialty
• Family Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.