Healthcare Provider Details

I. General information

NPI: 1134290406
Provider Name (Legal Business Name): AMBER LEE ZIETZ CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2006
Last Update Date: 10/06/2020
Certification Date: 10/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9340 SW BARNES RD SUITE 102
PORTLAND OR
97225-6623
US

IV. Provider business mailing address

9340 SW BARNES RD SUITE 102
PORTLAND OR
97225-6623
US

V. Phone/Fax

Practice location:
  • Phone: 503-216-2807
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number200850110NP
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number1717
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: