Healthcare Provider Details

I. General information

NPI: 1639203540
Provider Name (Legal Business Name): ELIZABETH ANNE RIBBECK RN, CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 03/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1285 LIBERTY ST SE
SALEM OR
97301-4243
US

IV. Provider business mailing address

1285 LIBERTY ST SE
SALEM OR
97301-4243
US

V. Phone/Fax

Practice location:
  • Phone: 503-562-4040
  • Fax:
Mailing address:
  • Phone: 503-562-4040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number200650117NP
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number739989
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: