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General NPI Number Information
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NPI Number | 1982555173
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Entity Type | Organization
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Legal Business Name | BIG MAMA DOULAS - GRANDMANEM STYLE
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Dates
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Enumeration Date | 02/04/2026
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Last Update Date | 02/13/2026
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Provider Practice Location Address
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Address Line | 24800 SE STARK ST
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City | GRESHAM
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State | OR
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Zip | 97030-3378
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Country | US
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Telephone | 503-674-1122
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Fax |
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Provider Business Mailing Address
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Address Line | 1087 SW DOTTIE CT
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City | TROUTDALE
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State | OR
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Zip | 97060-1215
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Country | US
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Telephone | 971-512-6022
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. LETISHA MCCOY
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Credential |
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Telephone | 971-488-8076
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QB0400X
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Taxonomy Name | Birthing Clinic/Center
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License Number |
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License Number State |
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