MEDICARE: MRS. NAOMI O'CALLAGHAN CPM

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	176B00000X	Midwife

General Provider Information

NPI Number	:	1952636805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NAOMI O'CALLAGHAN CPM

Provider Business Mailing Address
First Line	:	1901 NW 92ND ST
Second Line	:
City	:	VANCOUVER
State	:	WA
Zip	:	98665-6628
Country	:	US
Telephone Number	:	360-719-0208
Fax Number	:

Provider Business Practice Location Address
First Line	:	6632 JOHNNY LOVE LN
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89086-1368
Country	:	US
Telephone Number	:	702-595-1647
Fax Number	:

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

Provider Enumeration Date	:	10/09/2009
Last Update Date	:	09/14/2018

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