Provider Demographics
NPI:1093729790
Name:LEAFBLAD, BARBARA ANN (RN-CNM)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:ANN
Last Name:LEAFBLAD
Suffix:
Gender:F
Credentials:RN-CNM
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:A
Other - Last Name:BURKET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2925 CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-1321
Mailing Address - Country:US
Mailing Address - Phone:612-262-4813
Mailing Address - Fax:612-262-4194
Practice Address - Street 1:4194 LEXINGTON AVE N
Practice Address - Street 2:ARLINA MEDICAL CLINIC - SHOREVIEW
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126
Practice Address - Country:US
Practice Address - Phone:651-483-5461
Practice Address - Fax:651-483-2155
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2011-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNACNM4337367A00000X
MNR-1073269367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN680043200Medicaid
420000357Medicare ID - Type Unspecified
OTH000Medicare UPIN