Provider Demographics
NPI:1255691382
Name:FOSS, RIVER (CPM, LDM)
Entity Type:Individual
Prefix:
First Name:RIVER
Middle Name:
Last Name:FOSS
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 1:22515 BEAR CREEK RD
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-9489
Mailing Address - Country:US
Mailing Address - Phone:541-647-0490
Mailing Address - Fax:
Practice Address - Street 1:464 NE NORTON AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4387
Practice Address - Country:US
Practice Address - Phone:541-318-6961
Practice Address - Fax:541-389-8200
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-23
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDEM-LD-10148529176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife