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General NPI Number Information
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NPI Number | 1336464767
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Entity Type | Organization
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Legal Business Name | NEST MIDWIFERY
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Dates
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Enumeration Date | 03/29/2010
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Last Update Date | 03/29/2010
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Provider Practice Location Address
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Address Line | 2225 NE MLK BLVD
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City | PORTLAND
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State | OR
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Zip | 97212-3788
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Country | US
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Telephone | 503-449-4465
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Fax | 480-772-4995
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Provider Business Mailing Address
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Address Line | 2225 NE MLK BLVD
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City | PORTLAND
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State | OR
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Zip | 97212-3788
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Country | US
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Telephone | 503-449-4465
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Fax | 480-772-4995
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Authorized Official
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Title or Position | MIDWIFE/PARTNER
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Name | LAURIE PERRON MEDNICK
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Credential | CPM
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Telephone | 503-449-4465
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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-10129435
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License Number State | OR
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