Healthcare Provider Details

I. General information

NPI: 1013739176
Provider Name (Legal Business Name): NOVA VIDA MIDWIVES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2024
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3013 N NORTH BANK RD
OTIS OR
97368-9754
US

IV. Provider business mailing address

3013 N NORTH BANK RD
OTIS OR
97368-9754
US

V. Phone/Fax

Practice location:
  • Phone: 541-992-3738
  • Fax:
Mailing address:
  • Phone: 541-992-3738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MRS. CYNTHIA J LUXFORD
Title or Position: OWNER/SENIOR MIDWIFE
Credential: CPM-LDM
Phone: 541-992-3738