Provider Demographics
NPI:1265834311
Name:MOSER, LEANNA (FNP)
Entity Type:Individual
Prefix:
First Name:LEANNA
Middle Name:
Last Name:MOSER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 44440
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83711-0440
Mailing Address - Country:US
Mailing Address - Phone:208-888-1199
Mailing Address - Fax:208-888-0807
Practice Address - Street 1:5537 N GLENWOOD ST STE A
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83714-1336
Practice Address - Country:US
Practice Address - Phone:208-395-1090
Practice Address - Fax:208-395-1093
Is Sole Proprietor?:No
Enumeration Date:2014-09-19
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP-1522A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDNP-1522AOtherLICENSE