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General NPI Number Information
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NPI Number | 1255199907
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Entity Type | Individual
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Provider Name | ERIC PAUL LEEDAHL RN
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Gender | Male
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Dates
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Enumeration Date | 03/07/2024
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Last Update Date | 06/13/2025
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Provider Practice Location Address
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Address Line | 3000 32ND AVE S
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City | FARGO
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State | ND
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Zip | 58103-6132
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Country | US
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Telephone | 701-364-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 4742 51ST ST S
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City | FARGO
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State | ND
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Zip | 58104-6016
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Country | US
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Telephone | 701-866-8763
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | R46122
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License Number State | ND
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Taxonomy #2
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Taxonomy Code | 163WE0003X
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Taxonomy Name | Emergency Registered Nurse
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License Number | R46122
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License Number State | ND
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | R46122
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License Number State | ND
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