Provider Demographics
NPI:1194466946
Name:LEISNER, MICHELLE ZIPPORA (MS, MPH)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ZIPPORA
Last Name:LEISNER
Suffix:
Gender:F
Credentials:MS, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2247 SE 45TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-3727
Mailing Address - Country:US
Mailing Address - Phone:310-435-8159
Mailing Address - Fax:
Practice Address - Street 1:500 NE MULTNOMAH ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-2023
Practice Address - Country:US
Practice Address - Phone:877-221-8221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program