Healthcare Provider Details

I. General information

NPI: 1285040154
Provider Name (Legal Business Name): LEADI AMINOU RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2014
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2709 NORKENZIE RD
EUGENE OR
97408-7131
US

IV. Provider business mailing address

2709 NORKENZIE RD
EUGENE OR
97408-7131
US

V. Phone/Fax

Practice location:
  • Phone: 540-392-7696
  • Fax:
Mailing address:
  • Phone: 540-392-7696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10065325
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: