MEDICARE: MS. LAUREL LEE CNM MSN NP

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	363L00000X	Nurse Practitioner	084051307N5	OR
2	367A00000X	Advanced Practice Midwife	084051307N5	OR

General Provider Information

NPI Number	:	1801968649
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LAUREL LEE CNM MSN NP

Provider Business Mailing Address
First Line	:	240 NE 139TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97230
Country	:	US
Telephone Number	:	503-775-1957
Fax Number	:

Provider Business Practice Location Address
First Line	:	3231 SE 50TH AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97206
Country	:	US
Telephone Number	:	503-775-1957
Fax Number	:	503-788-7289

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

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	09/11/2025

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