Healthcare Provider Details

I. General information

NPI: 1932916558
Provider Name (Legal Business Name): MOLLY LESER IDHS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2024
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 1414
VALDEZ AK
99686-1414
US

IV. Provider business mailing address

PO BOX 1414
VALDEZ AK
99686-1414
US

V. Phone/Fax

Practice location:
  • Phone: 815-326-5973
  • Fax:
Mailing address:
  • Phone: 815-326-5973
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1710I1003X
TaxonomyIndependent Duty Medical Technicians
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: