Provider Demographics
NPI:1356464028
Name:LEONOVA, OLGA SERGIEVNA (QMHA)
Entity Type:Individual
Prefix:MS
First Name:OLGA
Middle Name:SERGIEVNA
Last Name:LEONOVA
Suffix:
Gender:F
Credentials:QMHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14132 SE TIBBETTS ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97236-2637
Mailing Address - Country:US
Mailing Address - Phone:503-869-9422
Mailing Address - Fax:
Practice Address - Street 1:14132 SE TIBBETTS ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97236-2637
Practice Address - Country:US
Practice Address - Phone:503-869-9422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered171M00000XOther Service ProvidersCase Manager/Care Coordinator
Not Answered372600000XNursing Service Related ProvidersAdult Companion