Healthcare Provider Details

I. General information

NPI: 1023936994
Provider Name (Legal Business Name): LEIGH BLOOMQUIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 1/2 W BENJAMIN AVE
NORFOLK NE
68701-2982
US

IV. Provider business mailing address

501 S HAMPTON ST
WAUSA NE
68786-2007
US

V. Phone/Fax

Practice location:
  • Phone: 402-370-2391
  • Fax: 402-370-2540
Mailing address:
  • Phone: 402-841-9148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: