Provider Demographics
NPI:1871820985
Name:LESKO, JULIE A (APRN)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:LESKO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22211 SE 42ND LN
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98029-7215
Mailing Address - Country:US
Mailing Address - Phone:425-390-5402
Mailing Address - Fax:425-375-7360
Practice Address - Street 1:3707 PROVIDENCE POINT DR SE STE G
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98029-6216
Practice Address - Country:US
Practice Address - Phone:425-390-5402
Practice Address - Fax:425-375-7360
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRN33983163W00000X
NVAPN0001415363LF0000X
WA60706003363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
2012015653OtherAMERICAN NURSE CREDENTIALING CENTER
NV0001415OtherAPRN
WA60706003OtherAPRN
2016004217OtherAMERICAN NURSE CREDENTIALING CENTER
NVRN33983OtherREGISTERED NURSE