Basic Information
| Provider Information | |||||||||
| NPI: | 1427146109 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HANSON | ||||||||
| FirstName: | LEAH | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | PMH-NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24 MAIN ST N | ||||||||
| Address2: | STE I | ||||||||
| City: | MINOT | ||||||||
| State: | ND | ||||||||
| PostalCode: | 587033104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7015007599 | ||||||||
| FaxNumber: | 7015168026 | ||||||||
| Practice Location | |||||||||
| Address1: | 1015 S BROADWAY STE 18 | ||||||||
| Address2: | |||||||||
| City: | MINOT | ||||||||
| State: | ND | ||||||||
| PostalCode: | 587014667 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7018578500 | ||||||||
| FaxNumber: | 7018578555 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2006 | ||||||||
| LastUpdateDate: | 05/02/2017 | ||||||||
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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 | 363LP0808X | R29510 | ND | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 54517 | 05 | ND | MEDICAID |