Provider Demographics
NPI:1124718184
Name:TAYLOR, LEAH (WHNP-BC)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3750 S RIVER PWKY
Mailing Address - Street 2:APT 605
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-4748
Mailing Address - Country:US
Mailing Address - Phone:503-901-5561
Mailing Address - Fax:
Practice Address - Street 1:9135 SW BARNES RD STE 761
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6777
Practice Address - Country:US
Practice Address - Phone:503-216-2602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-11
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10007080363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health