Provider Demographics
NPI:1407050081
Name:MOSHER, LEANNA MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:LEANNA
Middle Name:MARIE
Last Name:MOSHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LEANNA
Other - Middle Name:MARIE
Other - Last Name:MOSHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:19550 E 39TH ST S
Mailing Address - Street 2:SUITE 310
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64057-2303
Mailing Address - Country:US
Mailing Address - Phone:816-350-1828
Mailing Address - Fax:816-350-1844
Practice Address - Street 1:19550 E 39TH ST S
Practice Address - Street 2:SUITE 310
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-2303
Practice Address - Country:US
Practice Address - Phone:816-350-1828
Practice Address - Fax:816-350-1844
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006036876207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2006036876Other17
MO2006036876Other17