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General NPI Number Information
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NPI Number | 1407637275
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Entity Type | Organization
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Legal Business Name | MIDWIFE LENNON LLC
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Dates
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Enumeration Date | 10/09/2023
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Last Update Date | 10/09/2023
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Provider Practice Location Address
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Address Line | 330 BUSH ST SE
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City | SALEM
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State | OR
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Zip | 97302-4128
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Country | US
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Telephone | 503-999-1641
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Fax | 888-597-2525
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Provider Business Mailing Address
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Address Line | 533 CLARMAR DR NE
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City | SALEM
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State | OR
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Zip | 97301-4826
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Country | US
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Telephone | 503-999-1641
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Fax | 888-597-2525
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Authorized Official
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Title or Position | OWNER
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Name | LENNON CLARK
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Credential | CPM, LDEM
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Telephone | 503-999-1641
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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 |
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License Number State |
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