Provider Demographics
NPI:1366524969
Name:LEIGHTY, DENISE (APRN, CNP)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:LEIGHTY
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 UNIVERSITY AVE E
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-2507
Mailing Address - Country:US
Mailing Address - Phone:651-726-2836
Mailing Address - Fax:651-726-2836
Practice Address - Street 1:200 UNIVERSITY AVE E
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2507
Practice Address - Country:US
Practice Address - Phone:651-726-2836
Practice Address - Fax:651-726-2836
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1216864363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN819672900Medicaid
MN500003067Medicare PIN
Q45275Medicare UPIN