1366513640 NPI number — MRS. LESLIE MARIE STAPLETON RNC, MSN, NP

Table of content: MRS. LESLIE MARIE STAPLETON RNC, MSN, NP (NPI 1366513640)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366513640 NPI number — MRS. LESLIE MARIE STAPLETON RNC, MSN, NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STAPLETON
Provider First Name:
LESLIE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RNC, MSN, NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
AYDELOTT
Provider Other First Name:
LESLIE
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1366513640
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/11/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
801 SW 16TH ST
Provider Second Line Business Mailing Address:
STE 121
Provider Business Mailing Address City Name:
RENTON
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98057-2697
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
206-805-8886
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20696 BOND RD NE # C205
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POULSBO
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98370-9015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-930-3100
Provider Business Practice Location Address Fax Number:
360-633-3137
Provider Enumeration Date:
11/10/2006

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: 363LW0102X , with the licence number:  AP603368019 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 5282 . This is a "NURSE PRACTITIONER FURNIS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 5282 . This is a "NURSE PRACTITIONER CERTIF" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 392730 . This is a "RN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: AP 60368019 . This is a "ARNP" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: RN 60368017 . This is a "RN" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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