Healthcare Provider Details

I. General information

NPI: 1083257745
Provider Name (Legal Business Name): KATHLEEN LEANGEN RN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2019
Last Update Date: 10/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9650 15TH AVE SW
SEATTLE WA
98106-2576
US

IV. Provider business mailing address

9650 15TH AVE SW
SEATTLE WA
98106-2576
US

V. Phone/Fax

Practice location:
  • Phone: 206-229-5174
  • Fax:
Mailing address:
  • Phone: 206-229-5174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN60808456
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: