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NPI Code Detail

MEDICARE: MIKAYLA LEACH

MEDICARE: MIKAYLA LEACH
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
1163W00000XRegistered NurseR059910SD

General Provider Information

NPI Number : 1902738206
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIKAYLA LEACH
Provider Business Mailing Address
First Line : 408 S ROBERTS ST
Second Line :
City : HUMBOLDT
State : SD
Zip : 57035-2059
Country : US
Telephone Number : 210-863-9569
Fax Number :
Provider Business Practice Location Address
First Line : 2101 ELM ST N
Second Line :
City : FARGO
State : ND
Zip : 58102-2417
Country : US
Telephone Number : 701-232-3241
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2026
Last Update Date : 06/01/2026

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Directions to “ MIKAYLA LEACH ” Practice Location

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