Healthcare Provider Details

I. General information

NPI: 1710512652
Provider Name (Legal Business Name): MARIAH ROSE WHARTON CNM, DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. MARIAH ROSE WHARTON-BEHNIA

II. Dates (important events)

Enumeration Date: 03/11/2020
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3990 ABBEY LN STE B104
ASTORIA OR
97103-2237
US

IV. Provider business mailing address

1663 9TH ST
ASTORIA OR
97103-5225
US

V. Phone/Fax

Practice location:
  • Phone: 503-662-1294
  • Fax: 503-713-5322
Mailing address:
  • Phone: 808-936-6320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberCNM07986
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number201902782RN
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: