MEDICARE: RENAISSANCE CHILDBIRTH AND POSTPARTUM PROFESSIONALS LLC

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	374J00000X	Doula

General Provider Information

NPI Number	:	1194050591
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RENAISSANCE CHILDBIRTH AND POSTPARTUM PROFESSIONALS LLC

Provider Business Mailing Address
First Line	:	4311 NE ALBERTA ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97218-1519
Country	:	US
Telephone Number	:	503-493-7390
Fax Number	:

Provider Business Practice Location Address
First Line	:	4311 NE ALBERTA ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97218-1519
Country	:	US
Telephone Number	:	503-493-7390
Fax Number	:

Authorized Official
Title or Position	:	MEMBER/DOULA
Name	:	MRS. ERICA LYNN MATTESON
Credential	:	CD(DONA), PCD(DONA)
Telephone Number	:	503-493-7390

Provider Enumeration Date	:	10/02/2009
Last Update Date	:	10/02/2009

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