Healthcare Provider Details

I. General information

NPI: 1538505276
Provider Name (Legal Business Name): ABBY M. LUENSMANN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2013
Last Update Date: 11/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11197 W FAIRVIEW AVE
BOISE ID
83713-7935
US

IV. Provider business mailing address

PO BOX 191050
BOISE ID
83719-1050
US

V. Phone/Fax

Practice location:
  • Phone: 208-378-8011
  • Fax: 208-322-8095
Mailing address:
  • Phone: 208-985-6500
  • Fax: 208-955-6501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA125780
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM-12654
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: