=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700758844
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LEAH JEANNE POLLOCK MSN, AGPCNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/18/2025
-----------------------------------------------------
Last Update Date | 03/21/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 WASHINGTON AVE S STE 1210
-----------------------------------------------------
City | MINNEAPOLIS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55401-2511
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-217-2984
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 104 FRY CRK
-----------------------------------------------------
City | SAGLE
-----------------------------------------------------
State | ID
-----------------------------------------------------
Zip | 83860-9084
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 208-217-2984
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 61039
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------