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General NPI Number Information
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NPI Number | 1780675629
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Entity Type | Individual
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Provider Name | MICHELLE P PITTMAN-LEYENDECKER CNP
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Gender | Female
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Dates
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Enumeration Date | 10/31/2005
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Last Update Date | 12/21/2009
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Provider Practice Location Address
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Address Line | 4801 VETERANS DR
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City | SAINT CLOUD
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State | MN
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Zip | 56303-2015
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Country | US
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Telephone | 320-252-1670
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Fax | 320-255-6426
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Provider Business Mailing Address
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Address Line | 4801 VETERANS DR
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City | SAINT CLOUD
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State | MN
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Zip | 56303-2015
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Country | US
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Telephone | 320-252-1670
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Fax | 320-255-6426
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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 | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | R0952637
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License Number State | MN
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