Healthcare Provider Details

I. General information

NPI: 1851585376
Provider Name (Legal Business Name): LEIGH A HARMON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEIGH A CHASTEEN NP

II. Dates (important events)

Enumeration Date: 08/28/2007
Last Update Date: 07/08/2020
Certification Date: 07/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 BREN RD E
MINNETONKA MN
55343-9664
US

IV. Provider business mailing address

9900 BREN RD E
MINNETONKA MN
55343-9664
US

V. Phone/Fax

Practice location:
  • Phone: 866-686-2504
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0992297
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209008068
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3223
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: