Provider Demographics
NPI:1215634837
Name:ZWILLING, LEIA
Entity type:Individual
Prefix:
First Name:LEIA
Middle Name:
Last Name:ZWILLING
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 1:140 GRAND ST
Mailing Address - Street 2:
Mailing Address - City:PAYNESVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56362-4504
Mailing Address - Country:US
Mailing Address - Phone:320-291-2020
Mailing Address - Fax:
Practice Address - Street 1:502 2ND ST SW STE 1
Practice Address - Street 2:
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-3365
Practice Address - Country:US
Practice Address - Phone:320-235-7232
Practice Address - Fax:320-231-8602
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-14
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2467076163WR0006X
MN11555363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First Assistant