Healthcare Provider Details

I. General information

NPI: 1750535886
Provider Name (Legal Business Name): LEAH L KUYPER LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2008
Last Update Date: 04/27/2022
Certification Date: 04/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 BEACH AVE STE 1
MARYSVILLE WA
98270-4571
US

IV. Provider business mailing address

11508 20TH ST SE
LAKE STEVENS WA
98258-4751
US

V. Phone/Fax

Practice location:
  • Phone: 425-422-1558
  • Fax:
Mailing address:
  • Phone: 425-345-1933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA 00024829
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: