Healthcare Provider Details

I. General information

NPI: 1033192042
Provider Name (Legal Business Name): LEEANA G HAUSER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SNAKE RIVER PATHOLOGY

II. Dates (important events)

Enumeration Date: 11/22/2005
Last Update Date: 12/07/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 OAKLEY AVE #2
BURLEY ID
83318-0001
US

IV. Provider business mailing address

1321 OAKLEY AVE #2
BURLEY ID
83318-0001
US

V. Phone/Fax

Practice location:
  • Phone: 208-678-3063
  • Fax:
Mailing address:
  • Phone: 208-678-3063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberM-7101
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: