MS. LISA RAE HENNEN (APRN, CNP) – Family Nurse Practitioner, NPI 1588644454
Family Nurse Practitioner
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
5,720 NURSE PRACTITIONER in MN
Provider Addresses for MS. LISA RAE HENNEN (APRN, CNP)
13060 Isle Dr
Baxter, MN 564258331
Phone: (218) 828-2880
Type: Location
610 30th Avenue West
Alexandria Clinic
Alexandria, MN 56308
Phone: (320) 763-5123
Fax: (320) 763-7883
Type: Location
St. Cloud State University, 720, 4th Avenue South, St. Cloud, Stearns County, Minnesota, 56301, United States
SAINT CLOUD, MN 563014442
Phone: (320) 308-3191
Fax: (320) 308-3192
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
Loading prescription activity...
Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2003-11-25
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20031125000370 | I | Nurse Practitioner | MN | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 56425)
Loading plans...
Group practice members
| Name | Specialty | State |
|---|---|---|
| - | MN | |
| Nurse Practitioner | MN | |
| Certified Registered Nurse Anesthetist (Crna) | ND | |
| Nurse Practitioner | MN | |
| Emergency Medicine | MN | |
| Nurse Practitioner | MN | |
| Certified Registered Nurse Anesthetist (Crna) | MN | |
| Diagnostic Radiology | MN | |
| Nurse Practitioner | MN | |
| Hospitalist, Internal Medicine, Internal Medicine, Hospitalist | WI |
Reviews
All reviews are moderated before publication. Reviews reflect users' opinions; we do not verify the accuracy of individual reviews.
No reviews yet. Be the first to share your experience — your opinion helps families compare providers.