1255149225 NPI number — LESLIE EUNICE SHEEHY LEE FNP-C

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255149225 NPI number — LESLIE EUNICE SHEEHY LEE FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEE
Provider First Name:
LESLIE
Provider Middle Name:
EUNICE SHEEHY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHEEHY LEE
Provider Other First Name:
LESLIE
Provider Other Middle Name:
EUNICE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1255149225
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/16/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 16
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELYSIAN
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56028-0016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-334-9919
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7407 WAYZATA BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST LOUIS PARK
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55426-1619
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-927-4556
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/23/2024

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  2058209 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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