Provider Demographics
NPI:1104403807
Name:IRISH, LEAH G (CRNA)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:G
Last Name:IRISH
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2522 ENGLISH BENCH RD
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:IA
Mailing Address - Zip Code:52140-7542
Mailing Address - Country:US
Mailing Address - Phone:563-379-1035
Mailing Address - Fax:
Practice Address - Street 1:855 MANKATO AVE
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-4868
Practice Address - Country:US
Practice Address - Phone:507-454-3650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-27
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program