Provider Demographics
NPI:1003368515
Name:BADILLO, LEANNA (LM)
Entity Type:Individual
Prefix:
First Name:LEANNA
Middle Name:
Last Name:BADILLO
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25784 HOEHN RD
Mailing Address - Street 2:
Mailing Address - City:SEDRO WOOLLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98284-8371
Mailing Address - Country:US
Mailing Address - Phone:360-224-3138
Mailing Address - Fax:
Practice Address - Street 1:25784 HOEHN RD
Practice Address - Street 2:
Practice Address - City:SEDRO WOOLLEY
Practice Address - State:WA
Practice Address - Zip Code:98284-8371
Practice Address - Country:US
Practice Address - Phone:360-224-3138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-31
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMW 60650687176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife