Healthcare Provider Details

I. General information

NPI: 1487727889
Provider Name (Legal Business Name): MEREDITH ALEXIA LEASE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 06/16/2021
Certification Date: 06/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3075 N RESERVE ST STE Q
MISSOULA MT
59808-1390
US

IV. Provider business mailing address

PO BOX 12
LIBERTY LAKE WA
99019-0012
US

V. Phone/Fax

Practice location:
  • Phone: 406-327-1850
  • Fax: 406-327-1875
Mailing address:
  • Phone: 406-327-1850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number56047
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMED-PHYS-LIC-28192
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: