Healthcare Provider Details

I. General information

NPI: 1801960661
Provider Name (Legal Business Name): LESLIE JOY KVEENE RNC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 6TH STREET SE WOODLAND CENTERS
WILLMAR MN
56201-4675
US

IV. Provider business mailing address

6190 7TH AVE NW
WILLMAR MN
56201
US

V. Phone/Fax

Practice location:
  • Phone: 320-231-9148
  • Fax: 320-231-9140
Mailing address:
  • Phone: 320-235-4613
  • Fax: 320-231-9140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1265077
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: