Provider Demographics
NPI:1275825499
Name:NERENBERG, MIRRA LEAH (LDM,CPM, DEM)
Entity Type:Individual
Prefix:
First Name:MIRRA
Middle Name:LEAH
Last Name:NERENBERG
Suffix:
Gender:F
Credentials:LDM,CPM, DEM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3927 SE 64TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206
Mailing Address - Country:US
Mailing Address - Phone:503-432-7379
Mailing Address - Fax:917-228-1387
Practice Address - Street 1:1016 SE 12TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214
Practice Address - Country:US
Practice Address - Phone:503-432-7379
Practice Address - Fax:971-228-1387
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-05
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDEM-LD-10140879176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife