Provider Demographics
NPI:1205847548
Name:LEONE, JOANN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOANN
Middle Name:
Last Name:LEONE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:500 W FORT ST
Mailing Address - Street 2:DEPT 116 A
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-4501
Mailing Address - Country:US
Mailing Address - Phone:208-422-1108
Mailing Address - Fax:208-422-1241
Practice Address - Street 1:500 W FORT ST
Practice Address - Street 2:DEPT 116 A
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-4501
Practice Address - Country:US
Practice Address - Phone:208-422-1108
Practice Address - Fax:208-422-1241
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDM49492084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDVAD000Medicare UPIN