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General NPI Number Information
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NPI Number | 1417036849
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Entity Type | Organization
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Legal Business Name | ORCHARDS FAMILY MEDICINE, INC. PS
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Dates
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Enumeration Date | 11/05/2006
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Last Update Date | 10/19/2015
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Provider Practice Location Address
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Address Line | 9300 NE VANCOUVER MALL DR STE 201
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City | VANCOUVER
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State | WA
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Zip | 98662-8206
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Country | US
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Telephone | 360-567-0488
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Fax | 360-567-0489
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Provider Business Mailing Address
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Address Line | 9300 NE VANCOUVER MALL DR STE 201
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City | VANCOUVER
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State | WA
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Zip | 98662-8206
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Country | US
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Telephone | 360-567-0488
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Fax | 360-567-0489
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ELISE LEAF LELAND
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Credential | MD
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Telephone | 360-567-0488
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY60285535
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | P0515
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD00044580
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License Number State | WA
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