Healthcare Provider Details

I. General information

NPI: 1346519568
Provider Name (Legal Business Name): LEAH RENEE KANN CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEAH RENEE ROGGE

II. Dates (important events)

Enumeration Date: 12/16/2011
Last Update Date: 12/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 RIVERSIDE AVE
MINNEAPOLIS MN
55454-1450
US

IV. Provider business mailing address

420 DELAWARE ST SE MMC 96
MINNEAPOLIS MN
55455-0341
US

V. Phone/Fax

Practice location:
  • Phone: 612-365-6777
  • Fax: 612-624-1446
Mailing address:
  • Phone: 612-624-6666
  • Fax: 612-624-0644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberR177949-5
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: