=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700529922
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BYENVENI BABY, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/15/2022
-----------------------------------------------------
Last Update Date | 04/15/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12665 SW HALL BLVD
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97223-6217
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-724-4474
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7888 SW 87TH AVE
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97223-7008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-724-4474
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/MIDWIFE
-----------------------------------------------------
Name | SARA ELIZABETH HOLT
-----------------------------------------------------
Credential | CNM, MS, CAS
-----------------------------------------------------
Telephone | 503-724-4474
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 176B00000X
-----------------------------------------------------
Taxonomy Name | Midwife
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------