Provider Demographics
NPI:1073586632
Name:LEONARD, REBECCA M (CNP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:M
Last Name:LEONARD
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:MOEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5074
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5074
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6110 S. MINNESOTA AV.
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108
Practice Address - Country:US
Practice Address - Phone:605-328-5800
Practice Address - Fax:605-328-5814
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0301363L00000X
SDCP000301363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6821732Medicaid
SDS101203Medicare PIN
SDP00386159Medicare PIN
SDS100426Medicare PIN
SD6821732Medicaid