Individual
LEILANI LESTA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5211 NE GLISAN ST BLDG C, PORTLAND, OR 97213-3052
(550) 350-3250
Mailing address
5211 NE GLISAN ST BLDG C, PORTLAND, OR 97213-3052
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
172V00000X
—
OR
Enumeration date
01/16/2018
Last updated
01/16/2018
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