Provider Demographics
NPI:1114008935
Name:CODY, LESLIE (FNP)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:CODY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:LESLIE
Other - Middle Name:C
Other - Last Name:DINSMORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 3158
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3158
Mailing Address - Country:US
Mailing Address - Phone:503-215-6494
Mailing Address - Fax:
Practice Address - Street 1:5050 NE HOYT ST STE 117
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2955
Practice Address - Country:US
Practice Address - Phone:503-215-1874
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200650146NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR212979Medicaid
ORQ78144Medicare UPIN
OR137218Medicare PIN