Individual
BRIDGET MARY LEAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1618 N 27TH ST, BOISE, ID 83702-0115
(208) 720-0043
Mailing address
1618 N 27TH ST, BOISE, ID 83702-0115
(208) 720-0043
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
58997
ID
Other
Enumeration date
07/05/2018
Last updated
07/05/2018
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