Active NPI
Leah Dawn Berthiaume, RN
- Registered Nurse
- St Anthony, MN
National Provider Identifier
1912259656
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- R186580-4
- Practice address
- 2817 Anthony Lane S
Ste 311
St Anthony, MN 55418 - Phone
- (612) 789-0049
- Fax
- (651) 234-0864
- NPI assigned
- Oct 4, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | R186580-4 | MN | Primary |
Addresses
Primary practice location
2817 Anthony Lane S
Ste 311
St Anthony, MN 55418
Mailing address
2817 Anthony Lane S
Ste 311
St Anthony, MN 55418
Phone (612) 789-0049
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R186580-4 | MN | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1349308800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1349308800000",
"number": "1912259656",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2817 ANTHONY LANE S",
"address_2": "STE 311",
"city": "ST ANTHONY",
"state": "MN",
"postal_code": "55418",
"telephone_number": "612-789-0049",
"fax_number": "651-234-0864"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2817 ANTHONY LANE S",
"address_2": "STE 311",
"city": "ST ANTHONY",
"state": "MN",
"postal_code": "55418",
"telephone_number": "612-789-0049",
"fax_number": "651-234-0864"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERTHIAUME",
"first_name": "LEAH",
"middle_name": "DAWN",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-10-04",
"last_updated": "2012-10-04",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "MN",
"license": "R186580-4",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St Anthony, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.