Provider Demographics
NPI:1215985510
Name:HERON, LESLIE JEAN (APRN, FNP-BC)
Entity type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:JEAN
Last Name:HERON
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:MS
Other - First Name:LESLIE
Other - Middle Name:JEAN
Other - Last Name:VIETMEIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, FNP, BC
Mailing Address - Street 1:1100 FAIRVIEW AVENUE N, LF-261, (PO BOX 19024)
Mailing Address - Street 2:FRED HUTCHINSON CANCER RESEARCH CENTER
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-1024
Mailing Address - Country:US
Mailing Address - Phone:206-667-3249
Mailing Address - Fax:206-667-1502
Practice Address - Street 1:1100 FAIRVIEW AVENUE N, LF-261,
Practice Address - Street 2:FRED HUTCHINSON CANCER RESEARCH CENTER
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-1024
Practice Address - Country:US
Practice Address - Phone:206-667-3249
Practice Address - Fax:206-667-1502
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2015-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30003429363L00000X
WAAP30073429363LF0000X, 363L00000X
WARN00086540163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1215985510Medicaid
WAS59626Medicare UPIN
WA1215985510Medicaid