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General NPI Number Information
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NPI Number | 1275825499
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Entity Type | Individual
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Provider Name | MIRRA LEAH NERENBERG LDM,CPM, DEM
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Gender | Female
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Dates
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Enumeration Date | 05/05/2011
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Last Update Date | 11/09/2017
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Provider Practice Location Address
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Address Line | 1016 SE 12TH AVE
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City | PORTLAND
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State | OR
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Zip | 97214
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Country | US
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Telephone | 503-432-7379
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Fax | 971-228-1387
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Provider Business Mailing Address
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Address Line | 3927 SE 64TH AVE
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City | PORTLAND
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State | OR
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Zip | 97206
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Country | US
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Telephone | 503-432-7379
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Fax | 917-228-1387
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 176B00000X
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Taxonomy Name | Midwife
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License Number | DEM-LD-10140879
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License Number State | OR
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