Provider Demographics
NPI:1710190103
Name:AETHENA GYNECOLOGY ASSOCIATES, P.S.
Entity type:Organization
Organization Name:AETHENA GYNECOLOGY ASSOCIATES, P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:STRUXNESS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-693-7878
Mailing Address - Street 1:1498 SE TECH CENTER PLACE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683
Mailing Address - Country:US
Mailing Address - Phone:360-693-7878
Mailing Address - Fax:360-892-5724
Practice Address - Street 1:1498 SE TECH CENTER PLACE
Practice Address - Street 2:SUITE 100
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683
Practice Address - Country:US
Practice Address - Phone:360-693-7878
Practice Address - Fax:360-892-5724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30003214363LW0102X
207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7124332Medicaid
WA7124332Medicaid