Individual
MS. KIM ALIX LE BIAVANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C, WHNP-BC
Contact information
Practice address
5100 S MACADAM AVE STE 200, PORTLAND, OR 97239-3827
(971) 202-5500
Mailing address
5100 S MACADAM AVE STE 200, PORTLAND, OR 97239-3827
(971) 202-5500
(712) 025-5559
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
NP18110
CA
363LA2200X
Adult Health Nurse Practitioner
Primary
202003013NP-PP
OR
363LW0102X
Women's Health Nurse Practitioner
NP18110
CA
Other
Enumeration date
07/16/2008
Last updated
08/23/2021
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