Provider Demographics
NPI:1811520539
Name:MORRISON, LESLIE FAITH (CNM, APRN)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:FAITH
Last Name:MORRISON
Suffix:
Gender:F
Credentials:CNM, APRN
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:FAITH
Other - Last Name:MORRISON-SANDBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:17183 89TH PL N
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55311-1260
Mailing Address - Country:US
Mailing Address - Phone:612-306-1999
Mailing Address - Fax:
Practice Address - Street 1:555 CEDAR ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2209
Practice Address - Country:US
Practice Address - Phone:651-266-1255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-20
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN219367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife