Healthcare Provider Details

I. General information

NPI: 1588556625
Provider Name (Legal Business Name): DANA MARIE MONTGOMERY LEATHERMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2025
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VETERANS DR
MINNEAPOLIS MN
55417-2309
US

IV. Provider business mailing address

1 VETERANS DR
MINNEAPOLIS MN
55417-2309
US

V. Phone/Fax

Practice location:
  • Phone: 612-467-5802
  • Fax: 612-727-5973
Mailing address:
  • Phone: 612-467-5802
  • Fax: 612-727-5973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number1211089
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: