Healthcare Provider Details

I. General information

NPI: 1114719416
Provider Name (Legal Business Name): LEAH CORNISH CNA MEDICATION AIDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2025
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3634 600TH RD
RUSHVILLE NE
69360-5216
US

IV. Provider business mailing address

PO BOX 204
HAY SPRINGS NE
69347-0204
US

V. Phone/Fax

Practice location:
  • Phone: 308-629-7930
  • Fax:
Mailing address:
  • Phone: 308-629-7930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number126976
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: