MEDICARE: KRISTINA LEROY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374J00000X	Doula

General Provider Information

NPI Number	:	1104419860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINA LEROY

Provider Business Mailing Address
First Line	:	7760 157TH ST W
Second Line	:
City	:	APPLE VALLEY
State	:	MN
Zip	:	55124-9158
Country	:	US
Telephone Number	:	952-221-3692
Fax Number	:

Provider Business Practice Location Address
First Line	:	7760 157TH ST W
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55124-9158
Country	:	US
Telephone Number	:	952-221-3692
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2021
Last Update Date	:	02/14/2021

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Directions to “ KRISTINA LEROY ” Practice Location

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