Basic Information
| Provider Information | |||||||||
| NPI: | 1245984004 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MEHLING | ||||||||
| FirstName: | LEEANNE | ||||||||
| MiddleName: | JANAE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | C-NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1441 NE 10TH AVE | ||||||||
| Address2: | |||||||||
| City: | PAYETTE | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836615420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2086429376 | ||||||||
| FaxNumber: | 2086429598 | ||||||||
| Practice Location | |||||||||
| Address1: | 1219 SW 4TH AVE UNIT 1 | ||||||||
| Address2: | |||||||||
| City: | ONTARIO | ||||||||
| State: | OR | ||||||||
| PostalCode: | 979144500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5418892668 | ||||||||
| FaxNumber: | 5418892997 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2022 | ||||||||
| LastUpdateDate: | 05/18/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 70549 | ID | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.