Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | DEM-LD-10209555 | OR |
NPI | 1023629185 |
---|---|
Provider Name | Bethany Joy Loehrke |
First Address | Fairview, OR 97024-1810 |
Second Address | Gresham, OR 97080-7723 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2020 |
Last Update Date | 12/08/2020 |