Provider Demographics
NPI:1629007182
Name:ANDERSON, LEONA MARIE (DNP, AGPCNP-C)
Entity Type:Individual
Prefix:DR
First Name:LEONA
Middle Name:MARIE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:DNP, AGPCNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1843 STARVEOUT CREEK RD
Mailing Address - Street 2:
Mailing Address - City:AZALEA
Mailing Address - State:OR
Mailing Address - Zip Code:97410-9701
Mailing Address - Country:US
Mailing Address - Phone:541-837-8374
Mailing Address - Fax:
Practice Address - Street 1:101 1ST ST
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:OR
Practice Address - Zip Code:97442-9640
Practice Address - Country:US
Practice Address - Phone:541-832-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2020-08-10
Deactivation Date:2019-04-13
Deactivation Code:
Reactivation Date:2019-04-24
Provider Licenses
StateLicense IDTaxonomies
GARN091484163WX0200X
OR201805000NPPP363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163WX0200XNursing Service ProvidersRegistered NurseOncology