Provider Demographics
NPI:1467440784
Name:CLARKSEAN, LEANN (RN, CNP)
Entity Type:Individual
Prefix:
First Name:LEANN
Middle Name:
Last Name:CLARKSEAN
Suffix:
Gender:F
Credentials:RN, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5320 W 23RD ST STE 130
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-1670
Mailing Address - Country:US
Mailing Address - Phone:952-345-3213
Mailing Address - Fax:
Practice Address - Street 1:5320 W 23RD ST STE 130
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-1670
Practice Address - Country:US
Practice Address - Phone:952-345-3213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 122642-7363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN634541700Medicaid
MN500002673Medicare ID - Type Unspecified
MNS64537Medicare UPIN