Provider Demographics
NPI:1336674480
Name:PALOVICH, JANNAE (LM, BSM, CPM)
Entity Type:Individual
Prefix:
First Name:JANNAE
Middle Name:
Last Name:PALOVICH
Suffix:
Gender:F
Credentials:LM, BSM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8913 NE RUSSELL ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-5359
Mailing Address - Country:US
Mailing Address - Phone:208-818-2381
Mailing Address - Fax:
Practice Address - Street 1:8913 NE RUSSELL ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-5359
Practice Address - Country:US
Practice Address - Phone:208-818-2381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-26
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR374J00000X
ORDEM-LM-10236546176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No374J00000XNursing Service Related ProvidersDoula