Healthcare Provider Details

I. General information

NPI: 1891721437
Provider Name (Legal Business Name): LYNN R LEYBA NP, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1008 N GRAND AVE
PUEBLO CO
81003-2916
US

IV. Provider business mailing address

110 E ROUTT AVE
PUEBLO CO
81004-2117
US

V. Phone/Fax

Practice location:
  • Phone: 719-543-8711
  • Fax:
Mailing address:
  • Phone: 719-543-8711
  • Fax: 719-543-5340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License NumberAPN.0990713-NP
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number119829
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: