Provider Demographics
NPI:1073309514
Name:LEONARD, LISA (RN)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:LEONARD
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 N TANGLEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926-5185
Mailing Address - Country:US
Mailing Address - Phone:509-899-5642
Mailing Address - Fax:
Practice Address - Street 1:1202 N TANGLEWOOD CT
Practice Address - Street 2:
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-5185
Practice Address - Country:US
Practice Address - Phone:509-899-5642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-18
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00168777163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse