Provider Demographics
NPI:1083420566
Name:LEESON, MINDY
Entity type:Individual
Prefix:
First Name:MINDY
Middle Name:
Last Name:LEESON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 COTTONWOOD ST
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-4828
Mailing Address - Country:US
Mailing Address - Phone:218-289-3034
Mailing Address - Fax:
Practice Address - Street 1:924 COTTONWOOD ST
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-4828
Practice Address - Country:US
Practice Address - Phone:218-289-3034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant