Healthcare Provider Details

I. General information

NPI: 1487357844
Provider Name (Legal Business Name): LEAH ENGEBRETSON ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2023
Last Update Date: 03/24/2023
Certification Date: 03/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

971 11TH AVE
LONGVIEW WA
98632-2503
US

IV. Provider business mailing address

6325 SW BROAD OAK DR
BEAVERTON OR
97007-4625
US

V. Phone/Fax

Practice location:
  • Phone: 360-577-1771
  • Fax:
Mailing address:
  • Phone: 406-871-4503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP61415835
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: