Healthcare Provider Details

I. General information

NPI: 1548532187
Provider Name (Legal Business Name): JAMES MICHAEL LESNIAK PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2012
Last Update Date: 05/06/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 QUILEUTE HEIGHTS LOOP
LA PUSH WA
98350
US

IV. Provider business mailing address

560 QUILEUTE HEIGHTS LOOP
LA PUSH WA
98350
US

V. Phone/Fax

Practice location:
  • Phone: 360-374-9035
  • Fax: 360-374-2644
Mailing address:
  • Phone: 360-374-9035
  • Fax: 360-374-2644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110003790
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1162
License Number StateAK
# 3
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number61084841
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: