Provider Demographics
NPI:1043630122
Name:GARNER, CRISTYL DAWN (CPM, LDM)
Entity Type:Individual
Prefix:
First Name:CRISTYL
Middle Name:DAWN
Last Name:GARNER
Suffix:
Gender:F
Credentials:CPM, LDM
Other - Prefix:
Other - First Name:CRISTYL
Other - Middle Name:DAWN
Other - Last Name:MALCOM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10414 SE YUKON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-4235
Mailing Address - Country:US
Mailing Address - Phone:503-367-6767
Mailing Address - Fax:
Practice Address - Street 1:10414 SE YUKON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-4235
Practice Address - Country:US
Practice Address - Phone:503-367-6767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-16
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDEMLD10162477176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife