Provider Demographics
NPI:1336473263
Name:PURDY BENDER, SUSAN JAYNE (CPM LDM)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:JAYNE
Last Name:PURDY BENDER
Suffix:
Gender:F
Credentials:CPM LDM
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:BENDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:64463 WOLF CREEK LN
Mailing Address - Street 2:
Mailing Address - City:NORTH POWDER
Mailing Address - State:OR
Mailing Address - Zip Code:97867-9121
Mailing Address - Country:US
Mailing Address - Phone:541-898-2417
Mailing Address - Fax:
Practice Address - Street 1:64463 WOLF CREEK LN
Practice Address - Street 2:
Practice Address - City:NORTH POWDER
Practice Address - State:OR
Practice Address - Zip Code:97867-9121
Practice Address - Country:US
Practice Address - Phone:541-898-2417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-24
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDEM-LD-10128390176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife