Provider Demographics
NPI:1023200821
Name:WESSENBERG, LEAH BJORNSKOV (FNP)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:BJORNSKOV
Last Name:WESSENBERG
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:LEAH
Other - Middle Name:SUZANNE
Other - Last Name:BJORNSKOV
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:707 SW GAINES ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-2901
Mailing Address - Country:US
Mailing Address - Phone:503-494-7859
Mailing Address - Fax:503-494-4447
Practice Address - Street 1:707 SW GAINES ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239
Practice Address - Country:US
Practice Address - Phone:503-494-7859
Practice Address - Fax:503-494-4447
Is Sole Proprietor?:No
Enumeration Date:2007-08-15
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200440200RN163W00000X
OR200850086NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse