Healthcare Provider Details

I. General information

NPI: 1710377007
Provider Name (Legal Business Name): LEANN YAMANAKA NP-PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/26/2015
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 HINES ST SE STE 212
SALEM OR
97302-1307
US

IV. Provider business mailing address

1900 HINES ST SE STE 212
SALEM OR
97302-1307
US

V. Phone/Fax

Practice location:
  • Phone: 503-487-5859
  • Fax: 503-749-7842
Mailing address:
  • Phone: 503-487-5859
  • Fax: 503-749-7842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number200241699RN
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number201508793NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: