Healthcare Provider Details

I. General information

NPI: 1124754148
Provider Name (Legal Business Name): HEATHER MCCOOK CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2022
Last Update Date: 04/09/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1003 N PROVIDENCE DR STE 340
NEWBERG OR
97132-7521
US

IV. Provider business mailing address

7650 SW BEVELAND RD STE 200
PORTLAND OR
97223-8692
US

V. Phone/Fax

Practice location:
  • Phone: 503-538-2698
  • Fax: 503-554-9328
Mailing address:
  • Phone: 503-601-3615
  • Fax: 503-646-1683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number202201186NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: