MEDICARE: LEILANI DE JONG ARNP

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
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AP60491301	WA

General Provider Information

NPI Number	:	1619376530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEILANI DE JONG ARNP

Provider Business Mailing Address
First Line	:	4030 LAKE WASHINGTON BLVD NE STE 201
Second Line	:
City	:	KIRKLAND
State	:	WA
Zip	:	98033-7870
Country	:	US
Telephone Number	:	425-559-1482
Fax Number	:	844-729-1751

Provider Business Practice Location Address
First Line	:	4030 LAKE WASHINGTON BLVD NE STE 201
Second Line	:
City	:	KIRKLAND
State	:	WA
Zip	:	98033-7870
Country	:	US
Telephone Number	:	425-559-1482
Fax Number	:	844-729-1751

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/15/2014
Last Update Date	:	04/08/2025

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