Healthcare Provider Details

I. General information

NPI: 1033689153
Provider Name (Legal Business Name): MARY ELIZABETH LEONE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2018
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9775 SE SUNNYSIDE RD STE 200
CLACKAMAS OR
97015-5721
US

IV. Provider business mailing address

5020 NE 41ST AVE
PORTLAND OR
97211-8037
US

V. Phone/Fax

Practice location:
  • Phone: 503-535-3800
  • Fax:
Mailing address:
  • Phone: 440-476-0240
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201807354NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: