Healthcare Provider Details

I. General information

NPI: 1275498750
Provider Name (Legal Business Name): LEAH KATHRYN MCQUILLAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 PARK AVE
MINNEAPOLIS MN
55415-1623
US

IV. Provider business mailing address

966 COUNTY ROAD C2 W
ROSEVILLE MN
55113-1942
US

V. Phone/Fax

Practice location:
  • Phone: 612-873-3000
  • Fax:
Mailing address:
  • Phone: 651-235-8173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number207473-3
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: