Provider Demographics
NPI:1003131434
Name:PERRON MEDNICK, LAURIE (CPM)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:PERRON MEDNICK
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2225 NE MLK BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-3788
Mailing Address - Country:US
Mailing Address - Phone:503-449-4465
Mailing Address - Fax:480-772-4995
Practice Address - Street 1:2225 NE MLK BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-3788
Practice Address - Country:US
Practice Address - Phone:503-449-4465
Practice Address - Fax:480-772-4995
Is Sole Proprietor?:No
Enumeration Date:2010-03-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife