Healthcare Provider Details

I. General information

NPI: 1336340744
Provider Name (Legal Business Name): JACQUELINE ELAINE ROWAN CPM, LDEM, THW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 01/04/2024
Certification Date: 01/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2015 CAVES CAMP ROAD
WILLIAMS OR
97544
US

IV. Provider business mailing address

PO BOX 112
WILLIAMS OR
97544-0112
US

V. Phone/Fax

Practice location:
  • Phone: 541-846-8954
  • Fax: 541-846-8954
Mailing address:
  • Phone: 541-973-8793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License NumberTHW000110192
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code175M00000X
TaxonomyLay Midwife
License NumberDEM-LD-10118762
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: