Provider Demographics
NPI:1730122250
Name:LEITNER, ALEXIE ANN (PA)
Entity Type:Individual
Prefix:
First Name:ALEXIE
Middle Name:ANN
Last Name:LEITNER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2032 127TH LN NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55448-7057
Mailing Address - Country:US
Mailing Address - Phone:952-406-0155
Mailing Address - Fax:763-520-2707
Practice Address - Street 1:3800 LEXINGTON AVE N
Practice Address - Street 2:
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-2916
Practice Address - Country:US
Practice Address - Phone:952-406-0155
Practice Address - Fax:612-379-4936
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNMN10133363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant