Provider Demographics
NPI:1528376027
Name:LEBAS, NICOLE R (LMP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:R
Last Name:LEBAS
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12330 22ND AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-5208
Mailing Address - Country:US
Mailing Address - Phone:509-430-5148
Mailing Address - Fax:
Practice Address - Street 1:12330 22ND AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-5208
Practice Address - Country:US
Practice Address - Phone:509-430-5148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-17
Last Update Date:2010-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA 60169538174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist