Healthcare Provider Details

I. General information

NPI: 1760415202
Provider Name (Legal Business Name): SALEM WOMENS CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 10/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1395 LIBERTY ST SE
SALEM OR
97302-4276
US

IV. Provider business mailing address

1395 LIBERTY ST SE
SALEM OR
97302-4276
US

V. Phone/Fax

Practice location:
  • Phone: 503-399-2444
  • Fax: 503-581-3960
Mailing address:
  • Phone: 503-399-2444
  • Fax: 503-581-3960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number
License Number StateOR
# 4
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: ELIZEBETH R. HARMON
Title or Position: OWNER
Credential: M.D.
Phone: 503-399-2444