Provider Demographics
NPI:1619376530
Name:DE JONG, LEILANI (ARNP)
Entity Type:Individual
Prefix:
First Name:LEILANI
Middle Name:
Last Name:DE JONG
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11900 NE 1ST ST STE 300
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-3049
Mailing Address - Country:US
Mailing Address - Phone:425-214-7363
Mailing Address - Fax:844-729-1751
Practice Address - Street 1:11900 NE 1ST ST STE 300
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-3049
Practice Address - Country:US
Practice Address - Phone:425-214-7363
Practice Address - Fax:844-729-1751
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60491301363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health