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General NPI Number Information
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NPI Number | 1790865855
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Entity Type | Organization
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Legal Business Name | COLUMBIA GORGE MIDWIFERY
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2324 FREEDOM DR
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City | HOOD RIVER
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State | OR
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Zip | 97031-8671
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Country | US
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Telephone | 541-490-3140
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Fax | 541-386-8365
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Provider Business Mailing Address
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Address Line | 2324 FREEDOM DR
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City | HOOD RIVER
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State | OR
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Zip | 97031-8671
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Country | US
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Telephone | 541-490-3140
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Fax | 541-386-8365
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Authorized Official
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Title or Position | OWNER
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Name | MRS. LYNETTE TILLEY
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Credential | CPM,LDM
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Telephone | 541-490-3140
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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 | 10113722
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License Number State | OR
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