1215985510 NPI number — MS. LESLIE JEAN HERON APRN, FNP-BC

Table of content: RYAN JACKSON COULOMBE SUBMARINE IDC (NPI 1467000901)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215985510 NPI number — MS. LESLIE JEAN HERON APRN, FNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HERON
Provider First Name:
LESLIE
Provider Middle Name:
JEAN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
APRN, FNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VIETMEIER
Provider Other First Name:
LESLIE
Provider Other Middle Name:
JEAN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
APRN, FNP, BC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1215985510
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/30/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1100 FAIRVIEW AVENUE N, LF-261, (PO BOX 19024)
Provider Second Line Business Mailing Address:
FRED HUTCHINSON CANCER RESEARCH CENTER
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98109-1024
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-667-3249
Provider Business Mailing Address Fax Number:
206-667-1502

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 FAIRVIEW AVENUE N, LF-261,
Provider Second Line Business Practice Location Address:
FRED HUTCHINSON CANCER RESEARCH CENTER
Provider Business Practice Location Address City Name:
SEATTLE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98109-1024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-667-3249
Provider Business Practice Location Address Fax Number:
206-667-1502
Provider Enumeration Date:
05/05/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  AP30003429 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: AP30073429 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 163W00000X , with the licence number: RN00086540 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: AP30073429 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1215985510 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".