=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669700738
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ONDRA RAE WATSON CPM, LDM
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/30/2009
-----------------------------------------------------
Last Update Date | 11/30/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19295 SW HENNIG ST
-----------------------------------------------------
City | ALOHA
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97006-2412
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-350-2371
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19295 SW HENNIG ST
-----------------------------------------------------
City | ALOHA
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97006-2412
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 176B00000X
-----------------------------------------------------
Taxonomy Name | Midwife
-----------------------------------------------------
License Number | DEM-LD-10132453
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------