Basic Information
| Provider Information | |||||||||
| NPI: | 1841763232 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEININGER | ||||||||
| FirstName: | ALLYSSA | ||||||||
| MiddleName: | ANN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 502 3RD AVE E | ||||||||
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| City: | WEST FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 580781909 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2422 20TH ST SW | ||||||||
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| City: | JAMESTOWN | ||||||||
| State: | ND | ||||||||
| PostalCode: | 584016201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7019521050 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/08/2019 | ||||||||
| LastUpdateDate: | 02/06/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | R32438 | ND | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.