Healthcare Provider Details

I. General information

NPI: 1912482290
Provider Name (Legal Business Name): DEBORAH W ALBA CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2018
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2314 NW KINGS BLVD STE A
CORVALLIS OR
97330-3925
US

IV. Provider business mailing address

2314 NW KINGS BLVD STE A
CORVALLIS OR
97330-3925
US

V. Phone/Fax

Practice location:
  • Phone: 541-286-4030
  • Fax:
Mailing address:
  • Phone: 541-286-4030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number200041511RN
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number201808696NP-PP
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number201808696NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: