Provider Demographics
NPI:1861138703
Name:FRATTI, LEANNE MARIE (LPN CST)
Entity type:Individual
Prefix:MS
First Name:LEANNE
Middle Name:MARIE
Last Name:FRATTI
Suffix:
Gender:F
Credentials:LPN CST
Other - Prefix:
Other - First Name:LEANNE
Other - Middle Name:MARIE
Other - Last Name:LUSCHAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1776 W SAHARA DR
Mailing Address - Street 2:
Mailing Address - City:KUNA
Mailing Address - State:ID
Mailing Address - Zip Code:83634-5374
Mailing Address - Country:US
Mailing Address - Phone:208-484-5058
Mailing Address - Fax:208-888-5825
Practice Address - Street 1:520 S EAGLE RD
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-6351
Practice Address - Country:US
Practice Address - Phone:208-706-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-12
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID14481164W00000X
91815246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No164W00000XNursing Service ProvidersLicensed Practical Nurse