Individual
MS. IRINA LEONIDOVNA KISELEVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
705 ELM ST SW STE 200, ALBANY, OR 97321-1957
(541) 812-4850
Mailing address
PO BOX 1188, CORVALLIS, OR 97339-1188
Taxonomy
Speciality
Code
Description
License number
State
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
Primary
200950029NP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200950029NP
STATE LICENSE
OR
Enumeration date
08/19/2009
Last updated
11/03/2020
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