Individual
MRS. LEANNE M KOVICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CFM
Contact information
Practice address
2006 BLAINE ST, CALDWELL, ID 83605-4343
(208) 985-5404
(208) 402-5959
Mailing address
2006 BLAINE ST, CALDWELL, ID 83605-4343
(208) 985-5404
(208) 402-5959
Taxonomy
Speciality
Code
Description
License number
State
224900000X
Mastectomy Fitter
Primary
CFM02746
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1962804120
—
ID
Enumeration date
09/19/2014
Last updated
12/07/2015
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