1619901212 NPI number — MRS. LESLIE BROWN ARNP

Table of content: MRS. LESLIE BROWN ARNP (NPI 1619901212)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619901212 NPI number — MRS. LESLIE BROWN ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROWN
Provider First Name:
LESLIE
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MATHISON
Provider Other First Name:
LESLIE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
ARNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1619901212
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
450 S KITSAP BLVD STE 230
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORT ORCHARD
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98366-3738
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-895-0216
Provider Business Mailing Address Fax Number:
360-895-7919

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
450 S KITSAP BLVD STE 230
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT ORCHARD
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98366-3738
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-895-0216
Provider Business Practice Location Address Fax Number:
360-895-7919
Provider Enumeration Date:
07/10/2006

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: 363LP0200X , with the licence number:  AP30004805 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LP0200X , with the licence number: RN00118220 , 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: RN00118220 . This is a "RN" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: AP30004805 . This is a "AP" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 9624974 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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