Provider Demographics
NPI:1871693887
Name:LEANDER, JILL A (CNM)
Entity type:Individual
Prefix:MS
First Name:JILL
Middle Name:A
Last Name:LEANDER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3531 NE 15TH AVE STE B
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-2377
Mailing Address - Country:US
Mailing Address - Phone:503-775-4931
Mailing Address - Fax:
Practice Address - Street 1:3531 NE 15TH AVE STE B
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-2377
Practice Address - Country:US
Practice Address - Phone:503-775-4931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2008-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30005535367A00000X
OR082009978N5367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife