Healthcare Provider Details

I. General information

NPI: 1164954095
Provider Name (Legal Business Name): LEIGH RENEE COLTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2017
Last Update Date: 03/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18205 YEW WAY
SNOHOMISH WA
98296-5003
US

IV. Provider business mailing address

4303 SW CAMBRIDGE ST
SEATTLE WA
98136-2648
US

V. Phone/Fax

Practice location:
  • Phone: 509-520-3078
  • Fax:
Mailing address:
  • Phone: 509-520-3078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberLP60681576
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: