MR. LELAND CHARLES TEBOUT
NPI 1356058259
Registered Nurse - Ambulatory Care in Boise, ID
Active since October 31, 2022
About Mr. Leland Charles Tebout NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MR. LELAND CHARLES TEBOUT (NPI 1356058259) is an individual ambulatory care provider in Boise, Idaho, licensed in Georgia (RN122374) and active in the NPI registry since October 2022.
NPPES Registry Identity
NPI1356058259
Entity TypeIndividualMale
Primary Taxonomy163WP2201X
Provider Legal NameMR. LELAND CHARLES TEBOUT
Location Address500 W FORT STBoise, ID 83702-4501
Mailing Address1622 Paul Maddox RdJackson, GA 30233-4957 · (208) 422-1000
Phone(208) 422-1000
Sole ProprietorNo
Enumeration DateOctober 31, 2022
NPPES CertifiedOctober 31, 2022
✔ NPI 1356058259 is a valid, active identifier and passes the ISO check-digit test.
Specialties & Licenses
★ Primary SpecialtyRegistered Nurse · Ambulatory CareNursing Service Providers
Taxonomy Code163WP2201X
License✔ Licensed in GA · RN122374
500 W FORT ST, Boise, ID 83702
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1356058259, enumerated as an "individual" on October 31, 2022.
The provider is located at 500 W FORT ST BOISE, ID 83702 and the phone number is (208) 422-1000.
Registered Nurse with taxonomy code 163WP2201X and a focus in Ambulatory Care.
