Provider Demographics
NPI:1669057972
Name:ENRIQUEZ, LEAH KRISTEN (RN)
Entity type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:KRISTEN
Last Name:ENRIQUEZ
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:KRISTEN
Other - Last Name:ENRIQUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17404 GLACIER WAY APT 119
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-6458
Mailing Address - Country:US
Mailing Address - Phone:651-564-1320
Mailing Address - Fax:
Practice Address - Street 1:800 E 28TH ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-3799
Practice Address - Country:US
Practice Address - Phone:612-863-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2219323163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical