Healthcare Provider Details

I. General information

NPI: 1114008935
Provider Name (Legal Business Name): LESLIE CODY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LESLIE C DINSMORE NP

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11481 SW HALL BLVD STE 200
TIGARD OR
97223-8403
US

IV. Provider business mailing address

11481 SW HALL BLVD STE 200
PORTLAND OR
97223-8403
US

V. Phone/Fax

Practice location:
  • Phone: 503-980-4334
  • Fax: 971-200-2431
Mailing address:
  • Phone: 503-980-4334
  • Fax: 971-200-2431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number200650146NP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: