Provider Demographics
NPI:1902079585
Name:LEACH, RUTH ELIZABETH (RN, IBCLC)
Entity Type:Individual
Prefix:MS
First Name:RUTH
Middle Name:ELIZABETH
Last Name:LEACH
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:MS
Other - First Name:RUTH
Other - Middle Name:
Other - Last Name:LEACH-STEVENS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN, IBCLC
Mailing Address - Street 1:1140 MASONIC AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-2915
Mailing Address - Country:US
Mailing Address - Phone:415-703-0967
Mailing Address - Fax:
Practice Address - Street 1:1140 MASONIC AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-2915
Practice Address - Country:US
Practice Address - Phone:415-703-0967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-04
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN384385163W00000X, 163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant