Provider Demographics
NPI:1164891321
Name:SMITH, EMLIA MEGTALEENA (LDM, CPM)
Entity Type:Individual
Prefix:
First Name:EMLIA
Middle Name:MEGTALEENA
Last Name:SMITH
Suffix:
Gender:F
Credentials:LDM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1424 NE 74TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97213-6123
Mailing Address - Country:US
Mailing Address - Phone:503-805-1143
Mailing Address - Fax:
Practice Address - Street 1:1424 NE 74TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-6123
Practice Address - Country:US
Practice Address - Phone:503-805-1143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-17
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDEM-LD-10170627176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife