1568438182 NPI number — MS. CHRISTINE M. KENLAN-LAURENT CNM

Table of content: MS. CHRISTINE M. KENLAN-LAURENT CNM (NPI 1568438182)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568438182 NPI number — MS. CHRISTINE M. KENLAN-LAURENT CNM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KENLAN-LAURENT
Provider First Name:
CHRISTINE
Provider Middle Name:
M.
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CNM
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1568438182
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/09/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2800 N VANCOUVER AVE
Provider Second Line Business Mailing Address:
SUITE 255
Provider Business Mailing Address City Name:
PORTLAND
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97227-1630
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
503-413-4500
Provider Business Mailing Address Fax Number:
503-413-5222

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2800 N VANCOUVER AVE
Provider Second Line Business Practice Location Address:
SUITE 255
Provider Business Practice Location Address City Name:
PORTLAND
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97227-1630
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-413-4500
Provider Business Practice Location Address Fax Number:
503-413-5222
Provider Enumeration Date:
02/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367A00000X , with the licence number:  200150065NRNMNP-PP , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 9645979 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 297423 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




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