Healthcare Provider Details

I. General information

NPI: 1457799652
Provider Name (Legal Business Name): LEAH M HOCHSTEIN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEAH M GRIFFIN

II. Dates (important events)

Enumeration Date: 06/10/2013
Last Update Date: 04/29/2022
Certification Date: 04/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 WASHINGTON AVE
DETROIT LAKES MN
56501-3905
US

IV. Provider business mailing address

1027 WASHINGTON AVE
DETROIT LAKES MN
56501-3409
US

V. Phone/Fax

Practice location:
  • Phone: 218-846-2000
  • Fax: 218-846-2114
Mailing address:
  • Phone: 218-847-5611
  • Fax: 218-847-0881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberR190213-6
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR35599
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: