Individual
GENEVIEVE MARIE LEETHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
2280 AMERICAN LEGION BLVD, MOUNTAIN HOME, ID 83647-3142
(208) 587-3988
(208) 587-3324
Mailing address
2280 AMERICAN LEGION BLVD, MOUNTAIN HOME, ID 83647-3142
(208) 587-3988
(208) 587-3324
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
5905632-4405
UT
363LF0000X
Family Nurse Practitioner
Primary
NP-67308
ID
Other
Enumeration date
08/06/2019
Last updated
07/27/2021
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