Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | MD60139897 | WA |
N | 207ND0101X | MOHS-Micrographic Surgeon | MD60139897 | WA |
NPI | 1316029754 |
---|---|
Provider Name | Dr. Janie M Leonhardt |
First Address | Seattle, WA 98112-5211 |
Second Address | Seattle, WA 98112-5211 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2006 |
Last Update Date | 27/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
50D0966896 | CLIA (01) | WA |
I43303 | (02) | |
MD60139897 | LICENSE (01) | WA |