Healthcare Provider Details

I. General information

NPI: 1942693908
Provider Name (Legal Business Name): LEIGH WARSING PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEIGH JOHNSON PAC

II. Dates (important events)

Enumeration Date: 03/13/2015
Last Update Date: 02/12/2021
Certification Date: 02/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N GRAHAM ST SUITE 580
PORTLAND OR
97227-1654
US

IV. Provider business mailing address

300 N GRAHAM ST STE 125
PORTLAND OR
97227-1683
US

V. Phone/Fax

Practice location:
  • Phone: 503-528-0704
  • Fax: 503-528-0708
Mailing address:
  • Phone: 503-413-3714
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: