Basic Information
| Provider Information | |||||||||
| NPI: | 1538169933 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEIGHTON | ||||||||
| FirstName: | DANIELLE | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | VIETS | ||||||||
| OtherFirstName: | DANIELLE | ||||||||
| OtherMiddleName: | B | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 7366 | ||||||||
| Address2: | |||||||||
| City: | SAINT CLOUD | ||||||||
| State: | MN | ||||||||
| PostalCode: | 563027366 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3202575595 | ||||||||
| FaxNumber: | 3202575596 | ||||||||
| Practice Location | |||||||||
| Address1: | 1990 CONNECTICUT AVE S | ||||||||
| Address2: | |||||||||
| City: | SARTELL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 563772554 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3202575595 | ||||||||
| FaxNumber: | 3202575596 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2005 | ||||||||
| LastUpdateDate: | 03/03/2016 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 45571 | MN | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0204X | 45571 | MN | Y | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology |
ID Information
| ID | Type | State | Issuer | Description | 1841019 | 01 | MN | ARAZ/ AMERICA'S PPO | OTHER | 411772562 | 01 | MN | TRICARE | OTHER | 227M1LE | 01 | MN | BLUE CROSS BLUE SHIELD | OTHER | HP38570 | 01 | MN | HEALTH PARTNERS | OTHER | 16-02512 | 01 | MN | MEDICA | OTHER | 689438100 | 05 | MN | MEDICAID | 965251034498 | 01 | MN | PREFERRED ONE | OTHER | P00025240 | 01 | MN | RAILROAD MEDICARE | OTHER | 171485C561 | 01 | MN | UCARE OF MINNESOTA | OTHER | 411772562 | 01 | MN | GREATWEST HEALTHCARE | OTHER |