Provider Demographics
NPI:1831130434
Name:LEONETTI, RANDI (ARNP)
Entity Type:Individual
Prefix:
First Name:RANDI
Middle Name:
Last Name:LEONETTI
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:PO BOX 84965
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-6265
Mailing Address - Country:US
Mailing Address - Phone:425-899-0555
Mailing Address - Fax:425-899-1316
Practice Address - Street 1:12333 NE 130TH LN STE 320
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-7467
Practice Address - Country:US
Practice Address - Phone:425-899-0555
Practice Address - Fax:425-899-1316
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2012-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30004755363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9622267Medicaid
P00155463OtherRAILROAD MEDICARE
WAAP30004755OtherSTATE LICENSE NUMBER
S68689Medicare UPIN
WAAP30004755OtherSTATE LICENSE NUMBER
WA9622267Medicaid