Provider Demographics
NPI:1407327596
Name:WEBSTER, HEATHER MAE (CNM)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:MAE
Last Name:WEBSTER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16837 SE KNOLL RIDGE TER
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97267-5540
Mailing Address - Country:US
Mailing Address - Phone:781-346-5813
Mailing Address - Fax:
Practice Address - Street 1:9135 SW BARNES RD STE 761
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-6777
Practice Address - Country:US
Practice Address - Phone:503-216-2602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201400373RN163WX0003X
OR202009554NP-PP176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR201400373RNOtherRN-BSN