Healthcare Provider Details

I. General information

NPI: 1518321074
Provider Name (Legal Business Name): JOAN LEAVENS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2016
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 MERCER ST
SEATTLE WA
98109-4324
US

IV. Provider business mailing address

4600 92ND AVE SE
MERCER ISLAND WA
98040-4442
US

V. Phone/Fax

Practice location:
  • Phone: 206-489-2530
  • Fax: 206-489-2531
Mailing address:
  • Phone: 206-550-4683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD61174242
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberMD61174242
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: