Individual
ELIZABETH LEAVELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4531 SE BELMONT ST, STE 100, PORTLAND, OR 97215-1675
(503) 215-6556
Mailing address
4531 SE BELMONT ST, STE 100, PORTLAND, OR 97215-1675
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
089005220LPN
OR
302R00000X
Health Maintenance Organization
089005220LPN
OR
Other
Enumeration date
09/14/2012
Last updated
09/14/2012
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