Provider Demographics
NPI:1811525165
Name:LEITH, PRUDENCE N
Entity type:Individual
Prefix:
First Name:PRUDENCE
Middle Name:N
Last Name:LEITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7717 SE 42ND AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-8411
Mailing Address - Country:US
Mailing Address - Phone:503-504-6952
Mailing Address - Fax:
Practice Address - Street 1:7717 SE 42ND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-8411
Practice Address - Country:US
Practice Address - Phone:503-504-6952
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-31
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula