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NPI Code Detail

MEDICARE: NICOLE LEACH NP

MEDICARE: NICOLE LEACH NP
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
1363LF0000XFamily Nurse Practitioner10915MN

General Provider Information

NPI Number : 1528830585
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE LEACH NP
Provider Business Mailing Address
First Line : 2925 CHICAGO AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55407-1321
Country : US
Telephone Number : 612-262-5000
Fax Number :
Provider Business Practice Location Address
First Line : 2925 CHICAGO AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55407-1321
Country : US
Telephone Number : 612-863-4000
Fax Number : 763-236-3026
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/24/2023
Last Update Date : 02/11/2026

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Directions to “ NICOLE LEACH NP” Practice Location

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