Provider Demographics
NPI:1346423597
Name:LISE ANDERHEGGEN-LEIF, ARNP, PS
Entity Type:Organization
Organization Name:LISE ANDERHEGGEN-LEIF, ARNP, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:LISE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERHEGGEN-LEIF
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:206-525-8015
Mailing Address - Street 1:6804 47TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-7636
Mailing Address - Country:US
Mailing Address - Phone:206-525-8015
Mailing Address - Fax:206-525-8014
Practice Address - Street 1:5312 ROOSEVELT WAY NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-3629
Practice Address - Country:US
Practice Address - Phone:206-525-8015
Practice Address - Fax:206-525-8014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-11
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30002229363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty