Healthcare Provider Details

I. General information

NPI: 1730794306
Provider Name (Legal Business Name): CAPRI PARKER CPM, LDM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2020
Last Update Date: 09/10/2020
Certification Date: 09/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 SE 223RD AVE APT 1
GRESHAM OR
97030-2540
US

IV. Provider business mailing address

PO BOX 2011
FAIRVIEW OR
97024-1810
US

V. Phone/Fax

Practice location:
  • Phone: 503-539-1312
  • Fax:
Mailing address:
  • Phone: 503-539-1312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberDEM-LD-10210140
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: