Healthcare Provider Details

I. General information

NPI: 1366513640
Provider Name (Legal Business Name): LESLIE MARIE STAPLETON RNC, MSN, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS LESLIE MARIE AYDELOTT

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 05/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20696 BOND RD NE # C205
POULSBO WA
98370-9015
US

IV. Provider business mailing address

801 SW 16TH ST STE 121
RENTON WA
98057-2697
US

V. Phone/Fax

Practice location:
  • Phone: 360-930-3100
  • Fax: 360-633-3137
Mailing address:
  • Phone: 206-805-8886
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAP603368019
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: