Provider Demographics
NPI:1003422478
Name:LEUSCHEN, PAMELA LACEY (APRN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:LACEY
Last Name:LEUSCHEN
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 SIROCCO DR APT 2
Mailing Address - Street 2:
Mailing Address - City:MINOT AFB
Mailing Address - State:ND
Mailing Address - Zip Code:58704-1724
Mailing Address - Country:US
Mailing Address - Phone:501-628-7564
Mailing Address - Fax:
Practice Address - Street 1:2050 36TH AVE SW STE 201
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-7595
Practice Address - Country:US
Practice Address - Phone:701-852-8502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-21
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND49558363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily