Healthcare Provider Details

I. General information

NPI: 1164575502
Provider Name (Legal Business Name): LEANNE M ZILAR NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 04/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6203 AGENCY LOOP RD
WELLPINIT WA
99040
US

IV. Provider business mailing address

PO BOX 357
WELLPINIT WA
99040
US

V. Phone/Fax

Practice location:
  • Phone: 509-258-4517
  • Fax: 509-258-7152
Mailing address:
  • Phone: 509-258-4517
  • Fax: 509-258-7152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberAP30006344
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAP60248309
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP30006344
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: