Provider Demographics
NPI:1477903185
Name:SPANBAUER, KELSEY MARIE (CPM, LDM)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:MARIE
Last Name:SPANBAUER
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 1:1860 NE 4TH ST
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-3822
Mailing Address - Country:US
Mailing Address - Phone:541-788-0737
Mailing Address - Fax:541-797-5012
Practice Address - Street 1:1860 NE 4TH ST
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-3822
Practice Address - Country:US
Practice Address - Phone:541-788-0737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-14
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDEM-LD-10176916176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife