Provider Demographics
NPI:1942471388
Name:LEEANA HAUSER
Entity Type:Organization
Organization Name:LEEANA HAUSER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:LEEANA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAUSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-678-3063
Mailing Address - Street 1:1321 OAKLEY AVE
Mailing Address - Street 2:STE 2
Mailing Address - City:BURLEY
Mailing Address - State:ID
Mailing Address - Zip Code:83318-1859
Mailing Address - Country:US
Mailing Address - Phone:208-678-3063
Mailing Address - Fax:208-677-3111
Practice Address - Street 1:1321 OAKLEY AVE #2
Practice Address - Street 2:
Practice Address - City:BURLEY
Practice Address - State:ID
Practice Address - Zip Code:83318-0001
Practice Address - Country:US
Practice Address - Phone:208-678-3063
Practice Address - Fax:208-677-3111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-7101207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1400655Medicare PIN