Provider Demographics
NPI:1972651198
Name:WINANT, LEANNA (MD)
Entity Type:Individual
Prefix:
First Name:LEANNA
Middle Name:
Last Name:WINANT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21616 76TH AVE W
Mailing Address - Street 2:SUITE 109
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7512
Mailing Address - Country:US
Mailing Address - Phone:425-670-6788
Mailing Address - Fax:425-670-6795
Practice Address - Street 1:21616 76TH AVE W
Practice Address - Street 2:SUITE 109
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7512
Practice Address - Country:US
Practice Address - Phone:425-670-6788
Practice Address - Fax:425-670-6795
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00030264207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1090968Medicaid
WAAB20790Medicare ID - Type Unspecified
WA1090968Medicaid