MEDICARE: MAGEN LEEMAN PMHNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APN.1000968-NP	CO

General Provider Information

NPI Number	:	1598222317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAGEN LEEMAN PMHNP

Provider Business Mailing Address
First Line	:	703 MINNEQUA AVE
Second Line	:
City	:	PUEBLO
State	:	CO
Zip	:	81004-3721
Country	:	US
Telephone Number	:	303-775-7867
Fax Number	:

Provider Business Practice Location Address
First Line	:	1115 N GRAND AVE
Second Line	:
City	:	PUEBLO
State	:	CO
Zip	:	81003-2867
Country	:	US
Telephone Number	:	719-766-8511
Fax Number	:

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

Provider Enumeration Date	:	02/28/2019
Last Update Date	:	03/02/2026

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