Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 64100 | MN |
N | 2080A0000X | Adolescent Medicine | 28637 | MN |
NPI | 1205361805 |
---|---|
Provider Name | Leah Schmelkin Heidenreich |
First Address | Rochester, MN 55905-0001 |
Second Address | Rochester, MN 55905 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2017 |
Last Update Date | 25/08/2020 |