Provider Demographics
NPI:1427146109
Name:HANSON, LEAH ANN (PMH-NP)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:ANN
Last Name:HANSON
Suffix:
Gender:F
Credentials:PMH-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 MAIN ST N
Mailing Address - Street 2:STE I
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58703-3104
Mailing Address - Country:US
Mailing Address - Phone:701-500-7599
Mailing Address - Fax:701-516-8026
Practice Address - Street 1:1015 S BROADWAY STE 18
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-4667
Practice Address - Country:US
Practice Address - Phone:701-857-8500
Practice Address - Fax:701-857-8555
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR29510363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND54517Medicaid