Healthcare Provider Details

I. General information

NPI: 1952928723
Provider Name (Legal Business Name): LEAH MARIE TASSO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2020
Last Update Date: 10/23/2023
Certification Date: 10/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7920 OLD CEDAR AVE S
BLOOMINGTON MN
55425-1207
US

IV. Provider business mailing address

7520 ALDRICH AVE S.
RICHFIELD MN
55423
US

V. Phone/Fax

Practice location:
  • Phone: 952-428-1800
  • Fax: 952-428-1723
Mailing address:
  • Phone: 612-239-8443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF08190404
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: