Healthcare Provider Details

I. General information

NPI: 1477083103
Provider Name (Legal Business Name): MRS. LEANN M RUCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2017
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6520 SE 14TH ST
DES MOINES IA
50320-1846
US

IV. Provider business mailing address

6520 SE 14TH ST
DES MOINES IA
50320-1846
US

V. Phone/Fax

Practice location:
  • Phone: 515-266-1199
  • Fax:
Mailing address:
  • Phone: 515-953-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA134449
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA134449
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: