Healthcare Provider Details

I. General information

NPI: 1578061339
Provider Name (Legal Business Name): KANYA NOEL DELPOZZO CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2018
Last Update Date: 03/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

353 DEADMOND FERRY RD
SPRINGFIELD OR
97477-9406
US

IV. Provider business mailing address

3709 N BORTHWICK AVE
PORTLAND OR
97227-1220
US

V. Phone/Fax

Practice location:
  • Phone: 541-222-7750
  • Fax:
Mailing address:
  • Phone: 845-519-7479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number201703003NP-PP
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: