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General NPI Number Information
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NPI Number | 1174156418
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Entity Type | Individual
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Provider Name | LEA JO PIPER
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Gender | Female
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Dates
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Enumeration Date | 02/14/2020
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Last Update Date | 04/19/2021
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Provider Practice Location Address
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Address Line | 2855 E MAGIC VIEW DR
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City | MERIDIAN
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State | ID
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Zip | 83642-6245
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Country | US
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Telephone | 208-639-4900
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Fax |
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Provider Business Mailing Address
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Address Line | 3483 E EISENHOWER DR
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City | MERIDIAN
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State | ID
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Zip | 83642-6019
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Country | US
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Telephone | 208-539-3340
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | 19-165
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License Number State | ID
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