Healthcare Provider Details

I. General information

NPI: 1689930885
Provider Name (Legal Business Name): LESLIE FAYE RUFF BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2012
Last Update Date: 04/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 SAINT ANDREW ST STE100
LA CROSSE WI
54603-3301
US

IV. Provider business mailing address

613 E 2ND ST
WINONA MN
55987-4220
US

V. Phone/Fax

Practice location:
  • Phone: 608-785-6266
  • Fax:
Mailing address:
  • Phone: 507-961-0433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number172012-30
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number172953-9R-
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number130220
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: