MEDICARE: MS. SARAH HATHAWAY TAYLOR LDEM

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	176B00000X	Midwife	176B00000X	OR

General Provider Information

NPI Number	:	1417135427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SARAH HATHAWAY TAYLOR LDEM

Provider Business Mailing Address
First Line	:	3351 NE BROADWAY ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97232-1816
Country	:	US
Telephone Number	:	503-805-4680
Fax Number	:

Provider Business Practice Location Address
First Line	:	3351 NE BROADWAY ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97232-1816
Country	:	US
Telephone Number	:	503-805-4680
Fax Number	:

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

Provider Enumeration Date	:	02/01/2008
Last Update Date	:	02/01/2008

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