Provider Demographics
NPI:1437215613
Name:LEITCH, NANCY A (MD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:A
Last Name:LEITCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14305 SOUTHCROSS DR W STE 110
Mailing Address - Street 2:
Mailing Address - City:BURNSVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55306-7011
Mailing Address - Country:US
Mailing Address - Phone:651-340-1064
Mailing Address - Fax:651-330-0429
Practice Address - Street 1:14001 RIDGEDALE DR STE 300
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-1783
Practice Address - Country:US
Practice Address - Phone:763-316-4407
Practice Address - Fax:952-303-3579
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN37892207N00000X
WI4302207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN43282300Medicaid
MN43282300Medicaid
MN070000264Medicare ID - Type Unspecified