Provider Demographics
NPI:1114699162
Name:HALES, EVA MARIE (CD, THW)
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:MARIE
Last Name:HALES
Suffix:
Gender:F
Credentials:CD, THW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 NE KINGWOOD ST
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-9029
Mailing Address - Country:US
Mailing Address - Phone:503-863-7041
Mailing Address - Fax:
Practice Address - Street 1:345 NE KINGWOOD ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-9029
Practice Address - Country:US
Practice Address - Phone:503-863-7041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORTHW000104441OtherOREGON HEALTH AUTHORITY