Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | DEM-LD-10143021 | OR |
NPI | 1134438039 |
---|---|
Provider Name | Jennifer T Childress |
First Address | Nehalem, OR 97131-9511 |
Second Address | Nehalem, OR 97131-9511 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2010 |
Last Update Date | 18/07/2011 |