Healthcare Provider Details

I. General information

NPI: 1780945014
Provider Name (Legal Business Name): LEAH KUIPERS NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2012
Last Update Date: 11/09/2020
Certification Date: 11/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 E 28TH ST SUITE 300
MINNEAPOLIS MN
55407-1139
US

IV. Provider business mailing address

9709 AVOCET ST NW
COON RAPIDS MN
55433-5326
US

V. Phone/Fax

Practice location:
  • Phone: 612-863-3900
  • Fax:
Mailing address:
  • Phone: 651-485-0532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number152989-4
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF0612054
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: