Healthcare Provider Details

I. General information

NPI: 1023101631
Provider Name (Legal Business Name): PHYLLIS LEPPKE HANSELL FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 NW 11TH ST STE E37
HERMISTON OR
97838-8604
US

IV. Provider business mailing address

600 NW 11TH ST #E37
HERMISTON OR
97838-8604
US

V. Phone/Fax

Practice location:
  • Phone: 541-567-5305
  • Fax: 541-667-3487
Mailing address:
  • Phone: 541-567-5305
  • Fax: 541-667-3487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number200050032NP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: