Healthcare Provider Details

I. General information

NPI: 1437215613
Provider Name (Legal Business Name): NANCY A LEITCH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14001 RIDGEDALE DR STE 300
MINNETONKA MN
55305-1783
US

IV. Provider business mailing address

14305 SOUTHCROSS DR W STE 110
BURNSVILLE MN
55306-7011
US

V. Phone/Fax

Practice location:
  • Phone: 763-316-4407
  • Fax: 952-303-3579
Mailing address:
  • Phone: 651-340-1064
  • Fax: 651-330-0429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number37892
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number4302
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: