Provider Demographics
NPI:1962559112
Name:LEONE, DANIEL J (NP-C)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:J
Last Name:LEONE
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3229
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3229
Mailing Address - Country:US
Mailing Address - Phone:855-229-6460
Mailing Address - Fax:503-893-6847
Practice Address - Street 1:4400 NE HALSEY ST BLDG 23
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-1545
Practice Address - Country:US
Practice Address - Phone:855-229-6460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR087000017N1 FNP-PP363LF0000X
WA60532967363LF0000X
MT102386363LF0000X
AK019896363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR831550001OtherBCBS
OR931176109OtherCOMMERCIAL
OR118286Medicaid
ORR121475Medicare ID - Type Unspecified
OR118286Medicaid