Provider Demographics
NPI:1447742077
Name:SABIN, KIMBERLY K (DOULA ,PPD,BEC,BSC)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:K
Last Name:SABIN
Suffix:
Gender:F
Credentials:DOULA ,PPD,BEC,BSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1239 GOFF RD
Mailing Address - Street 2:
Mailing Address - City:FOREST GROVE
Mailing Address - State:OR
Mailing Address - Zip Code:97116-2991
Mailing Address - Country:US
Mailing Address - Phone:541-733-4002
Mailing Address - Fax:
Practice Address - Street 1:1239 GOFF RD
Practice Address - Street 2:
Practice Address - City:FOREST GROVE
Practice Address - State:OR
Practice Address - Zip Code:97116
Practice Address - Country:US
Practice Address - Phone:541-733-4002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-30
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR82-2426165374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR82-2426165OtherDOULA