Doctor Name: | LESLIE D IVERSON |
NPI Number: | 1174621676 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | ARNP, MPH |
License Number: | 200350038NP |
Business Practice Address: | 51377 Old Portland Road Suite C Scappoose, OR - 97056 |
Business Phone Number: | 5034184222 |
Business Fax Number: | 5034184223 |
Mailing Address: | 51377 Sw Old Portland Rd, Suite C SCAPPOOSE |
State: | OR |
Postal Code: | 970564018 |
Phone Number: | 5034184222 |
Fax Number: | 5034184223 |
NPI Enumeration Date: | 09/20/2006 |
NPI Last Update Date: | 09/01/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 200350038NP |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OR |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |