Provider Demographics
NPI:1568059855
Name:LEONARD, ANGIE
Entity Type:Individual
Prefix:
First Name:ANGIE
Middle Name:
Last Name:LEONARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 2ND ST
Mailing Address - Street 2:
Mailing Address - City:PENN
Mailing Address - State:ND
Mailing Address - Zip Code:58362-6208
Mailing Address - Country:US
Mailing Address - Phone:701-350-8005
Mailing Address - Fax:
Practice Address - Street 1:109 2ND ST
Practice Address - Street 2:
Practice Address - City:PENN
Practice Address - State:ND
Practice Address - Zip Code:58362-6208
Practice Address - Country:US
Practice Address - Phone:701-350-8005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant