Healthcare Provider Details

I. General information

NPI: 1366573941
Provider Name (Legal Business Name): LEANNA JEAN RAY-COLBY APN,MN,RN,DE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEANNA JEAN RAY APN,MN,RN,DE.

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 03/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

243511 W HIGHWAY 101
PORT ANGELES WA
98363-9472
US

IV. Provider business mailing address

PO BOX 317
NEAH BAY WA
98357-0317
US

V. Phone/Fax

Practice location:
  • Phone: 360-452-6252
  • Fax:
Mailing address:
  • Phone: 360-452-6252
  • Fax: 360-452-6274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberRN00060254
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: