Healthcare Provider Details

I. General information

NPI: 1275627911
Provider Name (Legal Business Name): LEANN FAYE ALEXANDER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 09/09/2022
Certification Date: 09/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46314 TIMINE WAY
PENDLETON OR
97801
US

IV. Provider business mailing address

PO BOX 24 46523 MISSION ROAD #24
PENDLETON OR
97801
US

V. Phone/Fax

Practice location:
  • Phone: 541-966-9830
  • Fax:
Mailing address:
  • Phone: 541-278-4025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number200441697 RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: