Provider Demographics
NPI:1255908489
Name:MALMIN, LENARD L JR (CNP)
Entity type:Individual
Prefix:
First Name:LENARD
Middle Name:L
Last Name:MALMIN
Suffix:JR
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3609 E WICKLOW AVE
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83686-1405
Mailing Address - Country:US
Mailing Address - Phone:208-697-7781
Mailing Address - Fax:208-498-9993
Practice Address - Street 1:3609 E WICKLOW AVE
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83686-1405
Practice Address - Country:US
Practice Address - Phone:208-697-7781
Practice Address - Fax:208-498-9993
Is Sole Proprietor?:No
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ID67470363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily