Healthcare Provider Details

I. General information

NPI: 1407327596
Provider Name (Legal Business Name): HEATHER MAE WEBSTER CNM, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 S BANCROFT ST STE B
PORTLAND OR
97239-8523
US

IV. Provider business mailing address

16837 SE KNOLL RIDGE TER
MILWAUKIE OR
97267-5540
US

V. Phone/Fax

Practice location:
  • Phone: 971-328-1565
  • Fax: 206-385-7376
Mailing address:
  • Phone: 781-346-5813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License Number201400373RN
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number202009554NP-PP
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberARNP.AP.70000379-CNM
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberARNP.AP.70012847-NP
License Number StateWA
# 5
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number202009554NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: