Provider Demographics
NPI:1831434349
Name:EKSTROM, LEANNE GRACE (DOM)
Entity type:Individual
Prefix:MS
First Name:LEANNE
Middle Name:GRACE
Last Name:EKSTROM
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 17TH ST NW STE 413
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20006-2615
Mailing Address - Country:US
Mailing Address - Phone:202-505-8081
Mailing Address - Fax:
Practice Address - Street 1:910 17TH ST NW STE 413
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20006-2615
Practice Address - Country:US
Practice Address - Phone:202-505-8081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-10
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCAC500160171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist