Healthcare Provider Details

I. General information

NPI: 1003639295
Provider Name (Legal Business Name): CEISHA LEINGANG RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2024
Last Update Date: 11/05/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 ELM ST N
FARGO ND
58102-2417
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:
Mailing address:
  • Phone: 701-255-2048
  • Fax: 701-255-2066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR29730
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: