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NPI Code Detail

MEDICARE: MR. NATHANIEL BRANDON LEAHY LAC.

MEDICARE: MR. NATHANIEL BRANDON LEAHY LAC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171100000XAcupuncturistAC60071465WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1AC60071465OTHERWAWASHINGTON STATE ACUPUNCTURE LICENSE

General Provider Information

NPI Number : 1376782128
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. NATHANIEL BRANDON LEAHY LAC.
Provider Business Mailing Address
First Line : 16821 SE MCGILLIVRAY BLVD STE 110
Second Line :
City : VANCOUVER
State : WA
Zip : 98683-0401
Country : US
Telephone Number : 360-953-8740
Fax Number :
Provider Business Practice Location Address
First Line : 16821 SE MCGILLIVRAY BLVD STE 110
Second Line :
City : VANCOUVER
State : WA
Zip : 98683-0401
Country : US
Telephone Number : 360-953-8740
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/17/2009
Last Update Date : 09/14/2019

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Directions to “ MR. NATHANIEL BRANDON LEAHY LAC.” Practice Location

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