Healthcare Provider Details

I. General information

NPI: 1225450513
Provider Name (Legal Business Name): LEAH BORUFF RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2014
Last Update Date: 01/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 N ALLEN ST
CARSON IA
51525-4384
US

IV. Provider business mailing address

311 N ALLEN ST
CARSON IA
51525-4384
US

V. Phone/Fax

Practice location:
  • Phone: 402-680-6670
  • Fax:
Mailing address:
  • Phone: 402-680-6670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number201394293RN
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number085665
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: