Provider Demographics
NPI:1841803624
Name:MISKOWIEC, LEAH ANNA MARIE (RD)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:ANNA MARIE
Last Name:MISKOWIEC
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2896 88TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-6761
Mailing Address - Country:US
Mailing Address - Phone:763-438-3131
Mailing Address - Fax:
Practice Address - Street 1:2896 88TH AVE NE
Practice Address - Street 2:
Practice Address - City:BLAINE
Practice Address - State:MN
Practice Address - Zip Code:55449-6761
Practice Address - Country:US
Practice Address - Phone:763-438-3131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN86168398133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered