Healthcare Provider Details

I. General information

NPI: 1043363146
Provider Name (Legal Business Name): GLENNA RUTH BRUFFY MS, RD, LD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 12/07/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 S 14TH ST
SAVANNAH MO
64485-1340
US

IV. Provider business mailing address

106 S 14TH ST
SAVANNAH MO
64485-1340
US

V. Phone/Fax

Practice location:
  • Phone: 816-324-3436
  • Fax:
Mailing address:
  • Phone: 816-324-3436
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2002014983
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: