Provider Demographics
NPI:1720055254
Name:LENEHAN, ELIZABETH ROSE (FAMILY NP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ROSE
Last Name:LENEHAN
Suffix:
Gender:F
Credentials:FAMILY NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 NW KINGS BLVD
Mailing Address - Street 2:CORVALLIS FAMILY MEDICINE
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330
Mailing Address - Country:US
Mailing Address - Phone:541-757-2400
Mailing Address - Fax:541-757-4719
Practice Address - Street 1:2400 NW KINGS BLVD
Practice Address - Street 2:CORVALLIS FAMILY MEDICINE
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330
Practice Address - Country:US
Practice Address - Phone:541-757-2400
Practice Address - Fax:541-757-4719
Is Sole Proprietor?:No
Enumeration Date:2006-03-03
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0000379891FNPPP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR037692Medicaid
Q10968Medicare UPIN
OR037692Medicaid