Provider Demographics
NPI:1164954095
Name:COLTON, LEIGH RENEE
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:RENEE
Last Name:COLTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4303 SW CAMBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98136-2648
Mailing Address - Country:US
Mailing Address - Phone:509-520-3078
Mailing Address - Fax:
Practice Address - Street 1:18205 YEW WAY
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98296-5003
Practice Address - Country:US
Practice Address - Phone:509-520-3078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-30
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP60681576164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse