1831130434 NPI number — RANDI LEONETTI ARNP

Table of content: RANDI LEONETTI ARNP (NPI 1831130434)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831130434 NPI number — RANDI LEONETTI ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEONETTI
Provider First Name:
RANDI
Provider Middle Name:
Provider Name Prefix Text:
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:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831130434
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/16/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 84965
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEATTLE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98124-6265
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-899-0555
Provider Business Mailing Address Fax Number:
425-899-1316

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12333 NE 130TH LN STE 320
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KIRKLAND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98034-7467
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-899-0555
Provider Business Practice Location Address Fax Number:
425-899-1316
Provider Enumeration Date:
06/08/2006

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:  AP30004755 , 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: 9622267 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00155463 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: AP30004755 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com