Provider Demographics
NPI:1114678679
Name:PAUL, MICHELLE RAEANN (DOULA)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:RAEANN
Last Name:PAUL
Suffix:
Gender:F
Credentials:DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3518 NE 152ND AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-7324
Mailing Address - Country:US
Mailing Address - Phone:360-909-7890
Mailing Address - Fax:
Practice Address - Street 1:3518 NE 152ND AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98682-7324
Practice Address - Country:US
Practice Address - Phone:360-909-7890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-15
Last Update Date:2022-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORTHW000105641OtherOREGON HEALTH AUTHORITY