Healthcare Provider Details

I. General information

NPI: 1649359464
Provider Name (Legal Business Name): BARBARA LEUSCHEN RD,LMNT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 W NORFOLK AVE
NORFOLK NE
68701-4438
US

IV. Provider business mailing address

1622 MULBERRY DR
NORFOLK NE
68701-3330
US

V. Phone/Fax

Practice location:
  • Phone: 402-371-4880
  • Fax:
Mailing address:
  • Phone: 401-644-7133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number223
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: