Provider Demographics
NPI:1568706760
Name:BURGESS, LESLIE VIRGINIA (ND)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:VIRGINIA
Last Name:BURGESS
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 N 68TH ST
Mailing Address - Street 2:APT #3
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-5318
Mailing Address - Country:US
Mailing Address - Phone:864-230-1752
Mailing Address - Fax:
Practice Address - Street 1:6300 9TH AVE NE
Practice Address - Street 2:SUITE #200
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-8515
Practice Address - Country:US
Practice Address - Phone:206-522-5646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-12
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60316027175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath