Healthcare Provider Details

I. General information

NPI: 1972548766
Provider Name (Legal Business Name): CAMILLE E. LEIDER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 02/23/2024
Certification Date: 02/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PEACEHEALTH SURGICAL SPECIALTIES 3355 RIVERBEND DR STE 300
SPRINGFIELD OR
97477
US

IV. Provider business mailing address

PEACEHEALTH SURGICAL SPECIALTIES 3355 RIVERBEND DR STE 300
SPRINGFIELD OR
97477
US

V. Phone/Fax

Practice location:
  • Phone: 541-222-8333
  • Fax: 541-222-8320
Mailing address:
  • Phone: 541-222-8333
  • Fax: 541-222-8320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number200450020NP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: