MEDICARE: MRS. LEIGHANNE B MCGOWAN RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WC1500X	Community Health Registered Nurse	080045345RN	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609958560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LEIGHANNE B MCGOWAN RN

Provider Business Mailing Address
First Line	:	91648 RIVER RD
Second Line	:
City	:	JUNCTION CITY
State	:	OR
Zip	:	97448-9403
Country	:	US
Telephone Number	:	503-319-2426
Fax Number	:	541-461-2498

Provider Business Practice Location Address
First Line	:	91648 RIVER RD
Second Line	:
City	:	JUNCTION CITY
State	:	OR
Zip	:	97448-9403
Country	:	US
Telephone Number	:	503-319-2426
Fax Number	:	541-461-2498

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	01/16/2013

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