Provider Demographics
NPI:1073876975
Name:COSBY, CARMEN (CPM, LDM)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:COSBY
Suffix:
Gender:F
Credentials:CPM, LDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3323 SW NAITO PKWY
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-4672
Mailing Address - Country:US
Mailing Address - Phone:503-885-0228
Mailing Address - Fax:503-274-0607
Practice Address - Street 1:3323 SW NAITO PKWY
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-4672
Practice Address - Country:US
Practice Address - Phone:503-885-0228
Practice Address - Fax:503-274-0607
Is Sole Proprietor?:No
Enumeration Date:2012-06-17
Last Update Date:2012-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDEM-LD-10148190175M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175M00000XOther Service ProvidersMidwife, Lay