Provider Demographics
NPI:1699914952
Name:JEDLICKI, LEAH (CRNA)
Entity type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:
Last Name:JEDLICKI
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26588 183RD AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:MN
Mailing Address - Zip Code:56368-8404
Mailing Address - Country:US
Mailing Address - Phone:320-333-7429
Mailing Address - Fax:
Practice Address - Street 1:10382 AUGUSTA DR
Practice Address - Street 2:
Practice Address - City:SAUK CENTRE
Practice Address - State:MN
Practice Address - Zip Code:56378-4864
Practice Address - Country:US
Practice Address - Phone:320-351-8422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-10
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN80795367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered