MEDICARE: TAWNIE ROBERDS

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
2	176B00000X	Midwife

General Provider Information

NPI Number	:	1316642101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAWNIE ROBERDS

Provider Business Mailing Address
First Line	:	7400 ASH ST
Second Line	:
City	:	GRAND RONDE
State	:	OR
Zip	:	97347-9404
Country	:	US
Telephone Number	:	208-907-2217
Fax Number	:

Provider Business Practice Location Address
First Line	:	7400 ASH ST
Second Line	:
City	:	GRAND RONDE
State	:	OR
Zip	:	97347-9404
Country	:	US
Telephone Number	:	208-907-2217
Fax Number	:

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

Provider Enumeration Date	:	04/03/2023
Last Update Date	:	04/03/2023

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Directions to “ TAWNIE ROBERDS ” Practice Location

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