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NPI Code Detail

MEDICARE: LEAH SPERRY GONZALEZ FNP

MEDICARE: LEAH SPERRY GONZALEZ FNP
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
1363L00000XNurse PractitionerCP000962SD

General Provider Information

NPI Number : 1902281447
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEAH SPERRY GONZALEZ FNP
Provider Business Mailing Address
First Line : 625 FLORMANN ST
Second Line :
City : RAPID CITY
State : SD
Zip : 57701-5469
Country : US
Telephone Number : 605-340-1234
Fax Number :
Provider Business Practice Location Address
First Line : 625 FLORMANN ST
Second Line :
City : RAPID CITY
State : SD
Zip : 57701-5469
Country : US
Telephone Number : 605-340-1234
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/27/2015
Last Update Date : 07/27/2025

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