Provider Demographics
NPI:1649359464
Name:LEUSCHEN, BARBARA (RD,LMNT)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:LEUSCHEN
Suffix:
Gender:F
Credentials:RD,LMNT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1622 MULBERRY DR
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-3330
Mailing Address - Country:US
Mailing Address - Phone:401-644-7133
Mailing Address - Fax:
Practice Address - Street 1:2700 W NORFOLK AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NE
Practice Address - Zip Code:68701-4438
Practice Address - Country:US
Practice Address - Phone:402-371-4880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE223133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE382142OtherCDR
NE47079687563Medicaid
NE275904Medicare ID - Type UnspecifiedMEDICARE WAYNE
NE47079687563Medicaid
NE382142OtherCDR
NE086055Medicare ID - Type UnspecifiedMEDICARE PLAINVIEW