Provider Demographics
NPI:1285187658
Name:LEESE, ALYSSA ANN (CNP)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:ANN
Last Name:LEESE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:ANN
Other - Last Name:LUND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNP
Mailing Address - Street 1:178 9TH ST E STE 300
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-2577
Mailing Address - Country:US
Mailing Address - Phone:877-440-1001
Mailing Address - Fax:
Practice Address - Street 1:178 9TH ST E STE 300
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2577
Practice Address - Country:US
Practice Address - Phone:877-440-1001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-02
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCNP4763363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily