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NPI Code Detail

MEDICARE: LEAH MULDOON NP

MEDICARE: LEAH MULDOON NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner58540ID

General Provider Information

NPI Number : 1275145047
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEAH MULDOON NP
Provider Business Mailing Address
First Line : 2000 N 27TH ST
Second Line :
City : BOISE
State : ID
Zip : 83702-0235
Country : US
Telephone Number : 281-630-1354
Fax Number :
Provider Business Practice Location Address
First Line : 425 W BANNOCK ST
Second Line :
City : BOISE
State : ID
Zip : 83702-6035
Country : US
Telephone Number : 208-343-6458
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2020
Last Update Date : 01/29/2026

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