Healthcare Provider Details

I. General information

NPI: 1497132815
Provider Name (Legal Business Name): LAUREN STUM BSM, CPM, LDM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2015
Last Update Date: 05/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 E ILLINOIS ST
NEWBERG OR
97132-2327
US

IV. Provider business mailing address

1530 E 1ST ST
NEWBERG OR
97132-3237
US

V. Phone/Fax

Practice location:
  • Phone: 503-747-8412
  • Fax:
Mailing address:
  • Phone: 503-487-6018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberDEM-LD-10168844
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: