Healthcare Provider Details

I. General information

NPI: 1962423160
Provider Name (Legal Business Name): LEANNA B TYSHLER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 05/10/2021
Certification Date: 05/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3218 NASSAU ST
EVERETT WA
98201-4139
US

IV. Provider business mailing address

20216 33RD AVE NE
LAKE FOREST PARK WA
98155-1539
US

V. Phone/Fax

Practice location:
  • Phone: 425-259-9225
  • Fax: 425-339-3381
Mailing address:
  • Phone: 206-363-9668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD00040231
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: