Provider Demographics
NPI:1417202110
Name:FLOURISH WOMEN'S WELLNESS
Entity Type:Organization
Organization Name:FLOURISH WOMEN'S WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MADRONE
Authorized Official - Suffix:
Authorized Official - Credentials:NP, CNM
Authorized Official - Phone:503-320-7819
Mailing Address - Street 1:3931 SE IVON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-1650
Mailing Address - Country:US
Mailing Address - Phone:503-320-7819
Mailing Address - Fax:
Practice Address - Street 1:3931 SE IVON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-1650
Practice Address - Country:US
Practice Address - Phone:503-320-7819
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200450053NP176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty