Provider Demographics
NPI:1902897507
Name:PUTNEY, LESSLI D (MD)
Entity Type:Individual
Prefix:
First Name:LESSLI
Middle Name:D
Last Name:PUTNEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LESSLI
Other - Middle Name:
Other - Last Name:HORNUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 5096
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98227-5096
Mailing Address - Country:US
Mailing Address - Phone:360-738-2200
Mailing Address - Fax:360-752-5678
Practice Address - Street 1:4545 CORDATA PKWY
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-7123
Practice Address - Country:US
Practice Address - Phone:360-738-2200
Practice Address - Fax:360-752-5678
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00044715208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1902897507Medicaid
WA7304698OtherAETNA
WA8426751Medicaid
WA0229980OtherL&I AND CRIME VICTIMS
WA1692HOOtherREGENCE
WA8426751Medicaid
WA0229980OtherL&I AND CRIME VICTIMS