Healthcare Provider Details

I. General information

NPI: 1235900911
Provider Name (Legal Business Name): SALEM MIDWIFE COLLECTIVE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2024
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 RAMSGATE SQ S
SALEM OR
97302-5864
US

IV. Provider business mailing address

342 MONMOUTH AVE S
MONMOUTH OR
97361-2110
US

V. Phone/Fax

Practice location:
  • Phone: 503-436-7414
  • Fax: 503-506-6902
Mailing address:
  • Phone: 503-436-7414
  • Fax: 503-506-6902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State

VIII. Authorized Official

Name: ANJA DESA FARIN
Title or Position: MEMBER, MIDWIFE
Credential:
Phone: 920-915-8951