Provider Demographics
NPI:1528539848
Name:LEDFORD, GRETA
Entity Type:Individual
Prefix:
First Name:GRETA
Middle Name:
Last Name:LEDFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 SILVER ST APT B
Mailing Address - Street 2:
Mailing Address - City:SILVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97381-1551
Mailing Address - Country:US
Mailing Address - Phone:971-800-1655
Mailing Address - Fax:
Practice Address - Street 1:16865 BOONES FERRY RD STE 101
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-5281
Practice Address - Country:US
Practice Address - Phone:503-699-6464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200940230163WS0200X
OR200940230RN163WS0121X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool
No163WS0121XNursing Service ProvidersRegistered NursePlastic Surgery