Healthcare Provider Details

I. General information

NPI: 1740621317
Provider Name (Legal Business Name): LEIGHA MARIE HUFFMAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2013
Last Update Date: 07/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 1ST AVE NE SUITE 100
BUFFALO MN
55313-1568
US

IV. Provider business mailing address

25 1ST AVE NE SUITE 100
BUFFALO MN
55313-1568
US

V. Phone/Fax

Practice location:
  • Phone: 763-682-3005
  • Fax:
Mailing address:
  • Phone: 763-682-3005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number201902-8
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: