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NPI Code Detail

MEDICARE: MICHELLE P PITTMAN-LEYENDECKER CNP

MEDICARE: MICHELLE P PITTMAN-LEYENDECKER CNP
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
1363LW0102XWomen's Health Nurse PractitionerR0952637MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10704160OTHERMEDICA HEALTH PLANS
21042819OTHERPREFERRED ONE
3078430300OTHERMEDICAL ASSISTANCE
4113181OTHERU CARE
5950S2P1OTHERBLUE CROSS BLUE SHIELD
62210957OTHERARAZ GROUP
7HP47689OTHERHEALTH PARTNERS

General Provider Information

NPI Number : 1780675629
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE P PITTMAN-LEYENDECKER CNP
Provider Business Mailing Address
First Line : 4801 VETERANS DR
Second Line :
City : SAINT CLOUD
State : MN
Zip : 56303-2015
Country : US
Telephone Number : 320-252-1670
Fax Number : 320-255-6426
Provider Business Practice Location Address
First Line : 4801 VETERANS DR
Second Line :
City : SAINT CLOUD
State : MN
Zip : 56303-2015
Country : US
Telephone Number : 320-252-1670
Fax Number : 320-255-6426
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/31/2005
Last Update Date : 12/21/2009

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