MEDICARE: KIMBERLY K SABIN DOULA ,PPD,BEC,BSC

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	82-2426165	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	82-2426165	OTHER	OR	DOULA

General Provider Information

NPI Number	:	1447742077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY K SABIN DOULA ,PPD,BEC,BSC

Provider Business Mailing Address
First Line	:	1239 GOFF RD
Second Line	:
City	:	FOREST GROVE
State	:	OR
Zip	:	97116-2991
Country	:	US
Telephone Number	:	541-733-4002
Fax Number	:

Provider Business Practice Location Address
First Line	:	1239 GOFF RD
Second Line	:
City	:	FOREST GROVE
State	:	OR
Zip	:	97116
Country	:	US
Telephone Number	:	541-733-4002
Fax Number	:

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

Provider Enumeration Date	:	05/30/2018
Last Update Date	:	06/11/2019

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