Healthcare Provider Details

I. General information

NPI: 1023200821
Provider Name (Legal Business Name): LEAH BJORNSKOV WESSENBERG FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEAH SUZANNE BJORNSKOV FNP

II. Dates (important events)

Enumeration Date: 08/15/2007
Last Update Date: 06/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 SW GAINES ST
PORTLAND OR
97239
US

IV. Provider business mailing address

707 SW GAINES ST
PORTLAND OR
97239-2901
US

V. Phone/Fax

Practice location:
  • Phone: 503-494-7859
  • Fax: 503-494-4447
Mailing address:
  • Phone: 503-494-7859
  • Fax: 503-494-4447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number200440200RN
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number200850086NP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: