Healthcare Provider Details

I. General information

NPI: 1447769070
Provider Name (Legal Business Name): TIFFANY ELLEN SEIDERS CPM, LDM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2017
Last Update Date: 07/21/2022
Certification Date: 07/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3017 NW 8TH ST
REDMOND OR
97756-1230
US

IV. Provider business mailing address

3017 NW 8TH ST
REDMOND OR
97756-1230
US

V. Phone/Fax

Practice location:
  • Phone: 541-728-1416
  • Fax:
Mailing address:
  • Phone: 541-728-1416
  • Fax: 541-516-8996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberDEMLD10186337
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: