MEDICARE: LEO LYNN ACKERMAN RN.FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	R 113240-1	MN
2	363LF0000X	Family Nurse Practitioner	R 113240-1	MN

General Provider Information

NPI Number	:	1356786685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEO LYNN ACKERMAN RN.FNP-BC

Provider Business Mailing Address
First Line	:	8982 35TH ST N
Second Line	:
City	:	LAKE ELMO
State	:	MN
Zip	:	55042-9200
Country	:	US
Telephone Number	:	651-779-9768
Fax Number	:

Provider Business Practice Location Address
First Line	:	8982 35TH ST N
Second Line	:
City	:	LAKE ELMO
State	:	MN
Zip	:	55042-9200
Country	:	US
Telephone Number	:	651-779-9768
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/30/2013
Last Update Date	:	04/30/2013

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