Healthcare Provider Details

I. General information

NPI: 1073876975
Provider Name (Legal Business Name): CARMEN COSBY CPM, LDM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2012
Last Update Date: 06/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3323 SW NAITO PKWY
PORTLAND OR
97239-4672
US

IV. Provider business mailing address

3323 SW NAITO PKWY
PORTLAND OR
97239-4672
US

V. Phone/Fax

Practice location:
  • Phone: 503-885-0228
  • Fax: 503-274-0607
Mailing address:
  • Phone: 503-885-0228
  • Fax: 503-274-0607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175M00000X
TaxonomyLay Midwife
License NumberDEM-LD-10148190
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: