Provider Demographics
NPI:1346614351
Name:LEOPOLD, LENA URSULA
Entity Type:Individual
Prefix:
First Name:LENA
Middle Name:URSULA
Last Name:LEOPOLD
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 1:2646 NW 62ND ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-2451
Mailing Address - Country:US
Mailing Address - Phone:303-946-5308
Mailing Address - Fax:
Practice Address - Street 1:2646 NW 62ND ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-2451
Practice Address - Country:US
Practice Address - Phone:303-946-5308
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-15
Last Update Date:2015-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALEOPOLU125LL390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program