Active NPI
Leslie Gynetta Gillis, LPN
- Licensed Practical Nurse
- Puyallup, WA
National Provider Identifier
1265848618
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Practical Nurse
- License
- LP00057512
- Practice address
- 325 E Pioneer
Puyallup, WA 98372-3265 - Phone
- (253) 697-8400
- NPI assigned
- Jul 7, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Practical Nurse | 164W00000X | LP00057512 | WA | Primary |
Addresses
Primary practice location
325 E Pioneer
Puyallup, WA 98372-3265
Mailing address
325 E Pioneer Ave
Puyallup, WA 98372
Phone (253) 697-8400
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LP00057512 | WA | MD | Licensed Practical Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1404691200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1265848618",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "325 E PIONEER AVE",
"city": "PUYALLUP",
"state": "WA",
"postal_code": "98372",
"telephone_number": "253-697-8400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "325 E PIONEER",
"city": "PUYALLUP",
"state": "WA",
"postal_code": "983723265",
"telephone_number": "253-697-8400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GILLIS",
"first_name": "LESLIE",
"middle_name": "GYNETTA",
"credential": "LPN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-07-07",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "164W00000X",
"taxonomy_group": "",
"desc": "Licensed Practical Nurse",
"state": "WA",
"license": "LP00057512",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Puyallup, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.