Provider Demographics
NPI:1538153770
Name:ABRASZEWSKI, LEE ANN ROBERTS (NP)
Entity type:Individual
Prefix:MS
First Name:LEE ANN
Middle Name:ROBERTS
Last Name:ABRASZEWSKI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:LEEANN
Other - Middle Name:ROBERTS
Other - Last Name:FOSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:465 MEMORIAL DRIVE
Mailing Address - Street 2:POCATELLO (ISU) FAMILY MEDICINE
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83209-0001
Mailing Address - Country:US
Mailing Address - Phone:208-282-4700
Mailing Address - Fax:208-282-4696
Practice Address - Street 1:POCATELLO (ISU) FAMILY MEDICINE
Practice Address - Street 2:465 MEMORIAL DRIVE
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83209-0001
Practice Address - Country:US
Practice Address - Phone:208-282-4700
Practice Address - Fax:208-282-4696
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP627A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806816900Medicaid
Q27325Medicare UPIN
ID806816900Medicaid