Healthcare Provider Details

I. General information

NPI: 1578102950
Provider Name (Legal Business Name): LESLIE BRUCHEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2020
Last Update Date: 01/02/2020
Certification Date: 01/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8330 NAAB RD
INDIANAPOLIS IN
46260-5925
US

IV. Provider business mailing address

400 STACY LEE CT
WESTMINSTER MD
21158-9421
US

V. Phone/Fax

Practice location:
  • Phone: 317-338-5100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberPENDING
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: