Provider Demographics
NPI:1467831511
Name:JOHNSDOTTIR, ASH ELIZABETH (CPM LDM)
Entity Type:Individual
Prefix:
First Name:ASH
Middle Name:ELIZABETH
Last Name:JOHNSDOTTIR
Suffix:
Gender:F
Credentials:CPM LDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 NE CONIFER BLVD APT B
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-4676
Mailing Address - Country:US
Mailing Address - Phone:541-908-9188
Mailing Address - Fax:
Practice Address - Street 1:152 NE CONIFER BLVD APT B
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-4676
Practice Address - Country:US
Practice Address - Phone:541-908-9188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-22
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDEMLD10169961176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife