Provider Demographics
NPI:1487301552
Name:HUBBARD, LESLIE (RN)
Entity type:Individual
Prefix:MRS
First Name:LESLIE
Middle Name:
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15216 140TH LN SE
Mailing Address - Street 2:
Mailing Address - City:YELM
Mailing Address - State:WA
Mailing Address - Zip Code:98597-9155
Mailing Address - Country:US
Mailing Address - Phone:253-970-1828
Mailing Address - Fax:
Practice Address - Street 1:19401 40TH AVE W STE 312
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-5600
Practice Address - Country:US
Practice Address - Phone:425-321-5742
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-08
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN60198507163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health