Provider Demographics
NPI:1538563085
Name:CATABAY-RILLERA, LEI-ANNE SIDENO (LPN)
Entity type:Individual
Prefix:MRS
First Name:LEI-ANNE
Middle Name:SIDENO
Last Name:CATABAY-RILLERA
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:LEI-ANNE
Other - Middle Name:SIDENO
Other - Last Name:CATABAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPN
Mailing Address - Street 1:4531 SE BELMONT ST STE 100
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-1675
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4531 SE BELMONT ST STE 100
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-1675
Practice Address - Country:US
Practice Address - Phone:503-215-6556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-13
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201130258LPN164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse