Provider Demographics
NPI:1356642672
Name:HEPP, LEILA RICHELLE (ARNP)
Entity Type:Individual
Prefix:MS
First Name:LEILA
Middle Name:RICHELLE
Last Name:HEPP
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 S 11TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-4000
Mailing Address - Country:US
Mailing Address - Phone:208-667-3113
Mailing Address - Fax:208-668-8213
Practice Address - Street 1:212 S 11TH ST STE 1
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-4000
Practice Address - Country:US
Practice Address - Phone:208-667-3113
Practice Address - Fax:951-466-2426
Is Sole Proprietor?:No
Enumeration Date:2010-11-03
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID75282363L00000X, 363LP0808X
WAAP60194889363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0276173OtherSTATE L&I
WA0276175OtherSTATE L&I
WAG8899452Medicare PIN