Provider Demographics
NPI:1700933173
Name:LEACH, MEGANNE E (PNP)
Entity Type:Individual
Prefix:
First Name:MEGANNE
Middle Name:E
Last Name:LEACH
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 S.W. GAINES ST
Mailing Address - Street 2:MAIL CODE: CDRCP
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-2984
Mailing Address - Country:US
Mailing Address - Phone:503-494-5856
Mailing Address - Fax:503-494-2370
Practice Address - Street 1:707 SW GAINES ST
Practice Address - Street 2:MAIL CODE CDRCP
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-2901
Practice Address - Country:US
Practice Address - Phone:503-494-5856
Practice Address - Fax:503-494-2307
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201709698NP-PP363LP0200X
DCRN1022483363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics