MEDICARE: ILANA PENA-GONZALEZ CNM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367A00000X	Advanced Practice Midwife	10015055	OR

General Provider Information

NPI Number	:	1083336887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ILANA PENA-GONZALEZ CNM

Provider Business Mailing Address
First Line	:	9155 SW BARNES RD STE 730
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97225-6634
Country	:	US
Telephone Number	:	503-216-4033
Fax Number	:

Provider Business Practice Location Address
First Line	:	333 SE 7TH AVE STE 5500
Second Line	:
City	:	HILLSBORO
State	:	OR
Zip	:	97123-4185
Country	:	US
Telephone Number	:	503-359-5564
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2022
Last Update Date	:	09/08/2025

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