Basic Information
| Provider Information | |||||||||
| NPI: | 1326232158 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEHN | ||||||||
| FirstName: | CASSANDRA | ||||||||
| MiddleName: | MICHELLE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | P.A. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HEINEN | ||||||||
| OtherFirstName: | CASSANDRA | ||||||||
| OtherMiddleName: | MICHELLE | ||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 251 COUNTY ROAD 120 | ||||||||
| Address2: | |||||||||
| City: | SAINT CLOUD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 563034872 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3202028949 | ||||||||
| FaxNumber: | 3202020756 | ||||||||
| Practice Location | |||||||||
| Address1: | 402 RED RIVER AVE N | ||||||||
| Address2: | |||||||||
| City: | COLD SPRING | ||||||||
| State: | MN | ||||||||
| PostalCode: | 563201521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3206858641 | ||||||||
| FaxNumber: | 3206854020 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/05/2007 | ||||||||
| LastUpdateDate: | 02/21/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 1326232158 | 05 | MN | MEDICAID |