Basic Information
| Provider Information | |||||||||
| NPI: | 1366519936 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEABHART | ||||||||
| FirstName: | LAURIE | ||||||||
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| Credential: | RN, CNS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8675 VALLEY CREEK ROAD | ||||||||
| Address2: | ALLINA MEDICAL CLINIC | ||||||||
| City: | WOODBURY | ||||||||
| State: | MN | ||||||||
| PostalCode: | 55125 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6512413000 | ||||||||
| FaxNumber: | 6512413503 | ||||||||
| Practice Location | |||||||||
| Address1: | 8675 VALLEY CREEK RD | ||||||||
| Address2: | |||||||||
| City: | WOODBURY | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551252337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6512413000 | ||||||||
| FaxNumber: | 6512413503 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2006 | ||||||||
| LastUpdateDate: | 05/15/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0808X | R1176506 | MN | N | Nursing Service Providers | Registered Nurse | Psych/Mental Health | 364S00000X | 18394201 | MN | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist |
ID Information
| ID | Type | State | Issuer | Description | 411425197 | 01 | MN | CIGNA BEHAVIORAL HEALTH | OTHER | 45F57LE | 01 | MN | BCBS | OTHER | 890000897 | 01 | MN | RR MEDICARE | OTHER | 6266267 | 01 | FM | MEDICA CHOICE | OTHER | HP17641 | 01 | MN | HEALTHPARTNERS | OTHER | 106238C154 | 01 | MN | UCARE | OTHER | 558555400 | 05 | MN | MEDICAID | ML03208440304 | 01 | MN | DEA | OTHER |