Individual
MISTY DAWN LEONARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2006 MAIN ST, VANCOUVER, WA 98660-2637
(360) 906-0826
Mailing address
3302 NE 130TH CT, VANCOUVER, WA 98682-7981
(360) 977-4091
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA60071897
WA
Other
Enumeration date
11/08/2010
Last updated
11/08/2010
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