Provider Demographics
NPI:1568199586
Name:LEARD, STEPHEN A
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:A
Last Name:LEARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13544 WILKEN RD NW
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MN
Mailing Address - Zip Code:56315-8204
Mailing Address - Country:US
Mailing Address - Phone:218-330-9300
Mailing Address - Fax:
Practice Address - Street 1:425 ELM ST N
Practice Address - Street 2:
Practice Address - City:SAUK CENTRE
Practice Address - State:MN
Practice Address - Zip Code:56378-1010
Practice Address - Country:US
Practice Address - Phone:320-352-2221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-01
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN14134363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant