Healthcare Provider Details

I. General information

NPI: 1902391535
Provider Name (Legal Business Name): LEANNA RUPP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2018
Last Update Date: 09/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 E BROAD ST
COLUMBUS OH
43213-1502
US

IV. Provider business mailing address

6001 E BROAD ST
COLUMBUS OH
43213-1502
US

V. Phone/Fax

Practice location:
  • Phone: 614-234-6590
  • Fax:
Mailing address:
  • Phone: 614-234-6590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License NumberRN.397943
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License NumberAPRN.CNP.023257
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: