Provider Demographics
NPI:1043367501
Name:MACKENZIE, LAUREN S (CNM)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:S
Last Name:MACKENZIE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:M
Other - Last Name:SCHMIDT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:7650 SW BEVELAND RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8692
Mailing Address - Country:US
Mailing Address - Phone:503-734-3800
Mailing Address - Fax:503-734-3808
Practice Address - Street 1:177 NE 102ND AVE
Practice Address - Street 2:BLDG V
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-4169
Practice Address - Country:US
Practice Address - Phone:503-734-3800
Practice Address - Fax:503-734-3808
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2006650150NP367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR158488OtherMEDICARE PTAN
OR247671Medicaid