Individual
LESLIE D IVERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP, MPH
Contact information
Practice address
51377 OLD PORTLAND ROAD, SUITE C, SCAPPOOSE, OR 97056
(503) 418-4222
(503) 418-4223
Mailing address
51377 SW OLD PORTLAND RD, SUITE C, SCAPPOOSE, OR 97056-4018
(503) 418-4222
(503) 418-4223
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
200350038NP
OR
Other
Enumeration date
09/20/2006
Last updated
09/01/2010
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