Leona Marie Anderson, DNP, AGPCNP-C
Individual provider Active NPI Primary Care Nurse Practitioner · Glendale, OR
NPI 1629007182 · NPPES record last updated Aug 10, 2020
Key facts
- NPI
- 1629007182
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Primary Care Nurse Practitioner 363LP2300X
- License
- 201805000NPPP (OR)
- Practice address
- 101 1St St
Glendale, OR 97442-9640 - Phone
- (541) 832-5400
- NPI assigned
- Jun 30, 2006
- Reactivated
- Apr 24, 2019
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OR
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20200627000011 | OR | Practitioner - Nurse Practitioner | 1052733607 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN091484 | GA | MD | Oncology Registered Nurse |
| 201805000NPPP | OR | MD | Primary Care Nurse Practitioner |
Interoperability endpoints
- leonaanderson@cwpcc.allscriptsdirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Oncology Registered Nurse | 163WX0200X | RN091484 | GA | |
| Primary Care Nurse Practitioner | 363LP2300X | 201805000NPPP | OR | Yes |
Addresses
Primary practice location
101 1St St
Glendale, OR 97442-9640
Mailing address
1843 Starveout Creek Rd
Azalea, OR 97410-9701
Phone (541) 837-8374
Other providers in Glendale, OR
- Robert J Briseno
- Donato and Wood Consulting Inc
- Glendale Community Primary Care
- Glendale Volunteer Ambulance Service
- Robert Sanchez
All providers in Glendale, OR · Primary Care Nurse Practitioner in Oregon
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 10, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.