Healthcare Provider Details

I. General information

NPI: 1902163561
Provider Name (Legal Business Name): LEAH J L WOJCIECHOWSKI P.A.-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2012
Last Update Date: 08/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 E 28TH ST STE 300
MINNEAPOLIS MN
55407-1195
US

IV. Provider business mailing address

920 E 28TH ST STE 300
MINNEAPOLIS MN
55407-1195
US

V. Phone/Fax

Practice location:
  • Phone: 612-863-3900
  • Fax: 612-863-6006
Mailing address:
  • Phone: 612-863-3900
  • Fax: 612-863-6006

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number11037
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: