Provider Demographics
NPI:1366519936
Name:LEABHART, LAURIE (RN, CNS)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:LEABHART
Suffix:
Gender:F
Credentials:RN, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8675 VALLEY CREEK ROAD
Mailing Address - Street 2:ALLINA MEDICAL CLINIC
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125
Mailing Address - Country:US
Mailing Address - Phone:651-241-3000
Mailing Address - Fax:651-241-3503
Practice Address - Street 1:8675 VALLEY CREEK RD
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-2337
Practice Address - Country:US
Practice Address - Phone:651-241-3000
Practice Address - Fax:651-241-3503
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR1176506163WP0808X
MN18394201364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN411425197OtherCIGNA BEHAVIORAL HEALTH
MN45F57LEOtherBCBS
MN890000897OtherRR MEDICARE
FM6266267OtherMEDICA CHOICE
MNHP17641OtherHEALTHPARTNERS
MN106238C154OtherUCARE
MN558555400Medicaid
MNML03208440304OtherDEA
MN890000146Medicare ID - Type Unspecified
MN558555400Medicaid