Provider Demographics
NPI:1336185677
Name:GAEDEKE, LEAH WESTERDAHL (MSN, FNP-C)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:WESTERDAHL
Last Name:GAEDEKE
Suffix:
Gender:F
Credentials:MSN, FNP-C
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:PAULINE
Other - Last Name:WESTERDAHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12672 NW BARNES RD. SUITE 100
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229
Mailing Address - Country:US
Mailing Address - Phone:503-747-6376
Mailing Address - Fax:503-530-8406
Practice Address - Street 1:12672 NW BARNES RD. SUITE 100
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229
Practice Address - Country:US
Practice Address - Phone:503-747-6376
Practice Address - Fax:503-530-8406
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200450116NP363LF0000X
VA0024165811363L00000X
OR200450116NP-PP363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORP00818471OtherRR MEDICARE - PHS
OR272568Medicaid
Q06752Medicare UPIN
OR272568Medicaid
ORR168820Medicare PIN