Provider Demographics
NPI:1205851748
Name:LEBEN, CONSTANCE CORA (PMHNP)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:CORA
Last Name:LEBEN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6400 SE LAKE RD STE 325
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97222-2185
Mailing Address - Country:US
Mailing Address - Phone:503-786-1711
Mailing Address - Fax:503-786-9919
Practice Address - Street 1:6400 SE LAKE RD STE 325
Practice Address - Street 2:
Practice Address - City:MILWAUKIE
Practice Address - State:OR
Practice Address - Zip Code:97222-2185
Practice Address - Country:US
Practice Address - Phone:503-786-1711
Practice Address - Fax:503-786-9919
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR000027822N6363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORQ35045Medicare UPIN
ORR130513Medicare ID - Type Unspecified