Healthcare Provider Details

I. General information

NPI: 1760269435
Provider Name (Legal Business Name): DANIELLE CHERIE LEE LE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2023
Last Update Date: 09/14/2023
Certification Date: 09/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

718 N MAIN AVE
GRESHAM OR
97030-7229
US

IV. Provider business mailing address

718 N MAIN AVE
GRESHAM OR
97030-7229
US

V. Phone/Fax

Practice location:
  • Phone: 971-666-7795
  • Fax:
Mailing address:
  • Phone: 971-666-7795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberBAP-E-10170832
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: