Individual
MS. LESLIE GINEVRA MONTGOMERY I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
700 PARKSIDE WAY, NAMPA, ID 83686-8247
(208) 703-7729
(208) 703-7729
Mailing address
11259 SOPRIS LOOP, CALDWELL, ID 83605-1009
(208) 703-7729
(208) 703-7729
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
CFH-6633
ID
Other
Enumeration date
05/20/2025
Last updated
05/20/2025
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