Provider Demographics
NPI:1578222048
Name:LEA, ANNA M (RN)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:M
Last Name:LEA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 KENWOOD AVE
Mailing Address - Street 2:C/O WESTWOOD ASSISTED LIVING
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811
Mailing Address - Country:US
Mailing Address - Phone:218-279-7650
Mailing Address - Fax:218-529-5746
Practice Address - Street 1:925 KENWOOD AVE
Practice Address - Street 2:C/O WESTWOOD ASSISTED LIVING
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811
Practice Address - Country:US
Practice Address - Phone:218-279-7650
Practice Address - Fax:218-529-5746
Is Sole Proprietor?:No
Enumeration Date:2021-12-13
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN180489-4163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse