Healthcare Provider Details

I. General information

NPI: 1063558807
Provider Name (Legal Business Name): JUNE ELLEN HOBBS CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 01/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24850 SE STARK ST SUITE 200
GRESHAM OR
97030-8316
US

IV. Provider business mailing address

24850 SE STARK ST SUITE 200
GRESHAM OR
97030-8316
US

V. Phone/Fax

Practice location:
  • Phone: 503-491-9444
  • Fax: 503-661-3430
Mailing address:
  • Phone: 503-491-9444
  • Fax: 503-661-3430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number200650131NP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: