Provider Demographics
NPI:1972548766
Name:LEIDER, CAMILLE E (NP)
Entity type:Individual
Prefix:
First Name:CAMILLE
Middle Name:E
Last Name:LEIDER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PEACEHEALTH SURGICAL SPECIALTIES
Mailing Address - Street 2:3355 RIVERBEND DR STE 300
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477
Mailing Address - Country:US
Mailing Address - Phone:541-222-8333
Mailing Address - Fax:541-222-8320
Practice Address - Street 1:PEACEHEALTH SURGICAL SPECIALTIES
Practice Address - Street 2:3355 RIVERBEND DR STE 300
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477
Practice Address - Country:US
Practice Address - Phone:541-222-8333
Practice Address - Fax:541-222-8320
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OR200450020NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR275061Medicaid
OR275061Medicaid
ORRR PTAN P00206841Medicare PIN
Q24286Medicare UPIN