Healthcare Provider Details

I. General information

NPI: 1851545230
Provider Name (Legal Business Name): LEILA DAWN THORNE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEILA DAWN STALNAKER

II. Dates (important events)

Enumeration Date: 11/11/2008
Last Update Date: 04/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 NE 139TH ST STE 200
VANCOUVER WA
98686-2316
US

IV. Provider business mailing address

PO BOX 2077
PORTLAND OR
97208-2077
US

V. Phone/Fax

Practice location:
  • Phone: 360-487-1777
  • Fax: 360-487-1779
Mailing address:
  • Phone: 503-413-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: