Provider Demographics
NPI:1215265079
Name:TOWNSEND, LEILANI R (DO)
Entity type:Individual
Prefix:
First Name:LEILANI
Middle Name:R
Last Name:TOWNSEND
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1703 S MERIDIAN STE 101
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-7590
Mailing Address - Country:US
Mailing Address - Phone:253-848-3000
Mailing Address - Fax:253-845-8750
Practice Address - Street 1:5225 CIRQUE DR W STE 200
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98467-3639
Practice Address - Country:US
Practice Address - Phone:253-848-3000
Practice Address - Fax:253-845-8750
Is Sole Proprietor?:No
Enumeration Date:2009-12-04
Last Update Date:2018-04-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAOP60387586207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2030105Medicaid