Healthcare Provider Details

I. General information

NPI: 1912102401
Provider Name (Legal Business Name): BETTY FAY GRIFFITH LDM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 04/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7745 SUNNYSIDE RD SE
SALEM OR
97306-9537
US

IV. Provider business mailing address

7745 SUNNYSIDE RD SE
SALEM OR
97306-9537
US

V. Phone/Fax

Practice location:
  • Phone: 503-362-2791
  • Fax: 503-362-2791
Mailing address:
  • Phone: 503-362-2791
  • Fax: 503-362-2791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175M00000X
TaxonomyLay Midwife
License NumberDEM-LD-926225
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberDEM-LD-926225
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: