Healthcare Provider Details

I. General information

NPI: 1740378132
Provider Name (Legal Business Name): LEAH JENNIFER MCNEILL ND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 11/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2310 130TH AVENUE NE I SUITE B-103
BELLEVUE WA
98005
US

IV. Provider business mailing address

2310 130TH AVENUE NE I SUITE B-103
BELLEVUE WA
98005
US

V. Phone/Fax

Practice location:
  • Phone: 425-881-2310
  • Fax: 425-881-2312
Mailing address:
  • Phone: 425-881-2310
  • Fax: 425-881-2312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberNT00000729
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberNT00000729
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: