Provider Demographics
NPI:1467003343
Name:DOULAS OF SALEM, LLC
Entity Type:Organization
Organization Name:DOULAS OF SALEM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED DOULA
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLEMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-510-0417
Mailing Address - Street 1:1655 CAPITOL ST NE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-7845
Mailing Address - Country:US
Mailing Address - Phone:503-877-2815
Mailing Address - Fax:
Practice Address - Street 1:1655 CAPITOL ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-7845
Practice Address - Country:US
Practice Address - Phone:503-877-2815
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty