Healthcare Provider Details

I. General information

NPI: 1619942323
Provider Name (Legal Business Name): LESLIE A CLAYTON PA C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LESLIE C MILTEER PAC

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 08/20/2021
Certification Date: 08/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8301 GOLDEN VALLEY RD STE 100
GOLDEN VALLEY MN
55427-4469
US

IV. Provider business mailing address

8100 34TH AVE S 21110Q
BLOOMINGTON MN
55425-1672
US

V. Phone/Fax

Practice location:
  • Phone: 763-581-5150
  • Fax:
Mailing address:
  • Phone: 952-883-5790
  • Fax: 952-883-5395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10024
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: