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General NPI Number Information
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NPI Number | 1356566517
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Entity Type | Individual
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Provider Name | MARY JANE DURHAM CPM,LDM
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Gender | Female
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Dates
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Enumeration Date | 04/14/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 9400 HIGHWAY 238
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City | JACKSONVILLE
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State | OR
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Zip | 97530-9554
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Country | US
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Telephone | 541-226-7061
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Fax | 541-899-9027
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Provider Business Mailing Address
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Address Line | 181 UPPER APPLEGATE RD # 273
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City | JACKSONVILLE
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State | OR
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Zip | 97530-9739
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Country | US
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Telephone | 541-899-3967
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Fax |
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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 | 175M00000X
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Taxonomy Name | Lay Midwife
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License Number | DEMLD10115742
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License Number State | OR
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