Healthcare Provider Details

I. General information

NPI: 1538169933
Provider Name (Legal Business Name): DANIELLE B LEIGHTON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DANIELLE B VIETS M.D.

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 03/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1990 CONNECTICUT AVE S
SARTELL MN
56377-2554
US

IV. Provider business mailing address

PO BOX 7366
SAINT CLOUD MN
56302-7366
US

V. Phone/Fax

Practice location:
  • Phone: 320-257-5595
  • Fax: 320-257-5596
Mailing address:
  • Phone: 320-257-5595
  • Fax: 320-257-5596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number45571
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number45571
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: