Leanne M Kovick, CFM

Primary specialty

Mastectomy FitterTaxonomy code 224900000X

License

CFM02746 Issued in ID

Practice address

2006 Blaine St
Caldwell, ID 83605-4343

Phone

(208) 985-5404

Fax

(208) 402-5959

NPI assigned

Sep 19, 2014

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1411084800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1449446400000",
    "number": "1962804120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2006 BLAINE ST",
            "city": "CALDWELL",
            "state": "ID",
            "postal_code": "836054343",
            "telephone_number": "208-985-5404",
            "fax_number": "208-402-5959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2006 BLAINE ST",
            "city": "CALDWELL",
            "state": "ID",
            "postal_code": "836054343",
            "telephone_number": "208-985-5404",
            "fax_number": "208-402-5959"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOVICK",
        "first_name": "LEANNE",
        "middle_name": "M",
        "name_prefix": "Mrs.",
        "credential": "CFM",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-09-19",
        "last_updated": "2015-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224900000X",
            "taxonomy_group": "",
            "desc": "Mastectomy Fitter",
            "state": "ID",
            "license": "CFM02746",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1962804120",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Mastectomy Fitter in Caldwell, ID
• Providers in Caldwell, ID by specialty
• Mastectomy Fitter in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.