Provider Demographics
NPI:1881053056
Name:LEAND, NICOLE (APRN, WHCNP)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:LEAND
Suffix:
Gender:F
Credentials:APRN, WHCNP
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:LUND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, WHCNP
Mailing Address - Street 1:1323 COON RAPIDS BLVD NW
Mailing Address - Street 2:
Mailing Address - City:COON RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55433-1312
Mailing Address - Country:US
Mailing Address - Phone:763-755-5300
Mailing Address - Fax:
Practice Address - Street 1:1323 COON RAPIDS BLVD NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-5307
Practice Address - Country:US
Practice Address - Phone:763-755-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-17
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR 204103-8363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health