Provider Demographics
NPI:1538999461
Name:LESUER, EMILY GRACE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:GRACE
Last Name:LESUER
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 W MAIN ST STE 1460
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-5983
Mailing Address - Country:US
Mailing Address - Phone:530-277-2047
Mailing Address - Fax:
Practice Address - Street 1:800 W MAIN ST STE 1460
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-5983
Practice Address - Country:US
Practice Address - Phone:530-277-2047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID2961665207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine