Healthcare Provider Details

I. General information

NPI: 1568263945
Provider Name (Legal Business Name): SUSAN WEHRLE CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2025
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 HENDERSON ST
FORT WORTH TX
76102-6026
US

IV. Provider business mailing address

1406 MARINE DR
ASTORIA OR
97103-3808
US

V. Phone/Fax

Practice location:
  • Phone: 817-924-2216
  • Fax:
Mailing address:
  • Phone: 503-468-0650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number1206579
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: