Healthcare Provider Details

I. General information

NPI: 1225057417
Provider Name (Legal Business Name): HEATHER M. LEIER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 E BROADWAY AVE RM 353
BISMARCK ND
58501-4082
US

IV. Provider business mailing address

304 E BROADWAY AVE RM 353
BISMARCK ND
58501-4082
US

V. Phone/Fax

Practice location:
  • Phone: 701-255-2048
  • Fax: 701-255-2066
Mailing address:
  • Phone: 701-255-2048
  • Fax: 701-255-2066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR26704
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR26704
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: