IndividualActive
Leland Tebout
NPI 1356058259 · Ambulatory Care Registered Nurse · Boise, ID
Provider details
- NPI number
- 1356058259
- Entity type
- Individual
- Primary specialty
- Ambulatory Care Registered NurseNursing Service Providers
- Sex
- Male
- Sole proprietor
- No
- License
- RN122374 (GA)
Specialties & taxonomies
Nursing Service Providers
Practice location
500 W Fort St
Boise, ID 83702-4501
Phone: (208) 422-1000
Approximate (ZIP-level) locationGet directions
Mailing address
1622 Paul Maddox Rd
Jackson, GA 30233-4957
Registry dates
- Enumerated
- 2022-10-31
- Last updated
- 2022-10-31
- Certified
- 2022-10-31
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.