Individual
KRISTINA MICHELLE LEIDICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
124 NE 181ST AVE STE 103, PORTLAND, OR 97230-6565
(503) 489-1760
Mailing address
18738 SE GRANT ST, PORTLAND, OR 97233-5518
(541) 499-8887
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
201911095NP-PP
OR
Other
Enumeration date
01/09/2020
Last updated
09/23/2025
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