Active NPI
Leslie Wiersum
- Specialist
- Kent, WA
National Provider Identifier
1598018269
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- OT60174905
- Practice address
- 12033 SE 256TH Street
Kent, WA 98030 - Phone
- (253) 373-7000
- NPI assigned
- Oct 18, 2012
- 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 |
|---|---|---|---|---|
| Specialist | 174400000X | OT60174905 | WA | Primary |
Addresses
Primary practice location
12033 SE 256TH Street
Kent, WA 98030
Mailing address
222 Queen Anne Ave
Seattle, WA 98109
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 |
|---|---|---|---|
| OT60174905 | WA | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1350518400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1350518400000",
"number": "1598018269",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "222 QUEEN ANNE AVE",
"city": "SEATTLE",
"state": "WA",
"postal_code": "98109"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12033 SE 256TH STREET",
"city": "KENT",
"state": "WA",
"postal_code": "98030",
"telephone_number": "253-373-7000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIERSUM",
"first_name": "LESLIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-10-18",
"last_updated": "2012-10-18",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "WA",
"license": "OT60174905",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kent, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.