Basic Information
| Provider Information | |||||||||
| NPI: | 1265077861 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MCLEOD | ||||||||
| FirstName: | KAYLA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1017 S BROADWAY STE 18 | ||||||||
| Address2: | |||||||||
| City: | MINOT | ||||||||
| State: | ND | ||||||||
| PostalCode: | 587014659 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7018578500 | ||||||||
| FaxNumber: | 7018578555 | ||||||||
| Practice Location | |||||||||
| Address1: | 1017 S BROADWAY STE 18 | ||||||||
| Address2: | |||||||||
| City: | MINOT | ||||||||
| State: | ND | ||||||||
| PostalCode: | 587014659 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7018578500 | ||||||||
| FaxNumber: | 7018578555 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2019 | ||||||||
| LastUpdateDate: | 11/07/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | R45023 | ND | Y | Nursing Service Providers | Registered Nurse |
No ID Information.