Provider Demographics
NPI:1497132815
Name:STUM, LAUREN (BSM, CPM, LDM)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:STUM
Suffix:
Gender:F
Credentials:BSM, CPM, LDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-3237
Mailing Address - Country:US
Mailing Address - Phone:503-487-6018
Mailing Address - Fax:
Practice Address - Street 1:208 E ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-2327
Practice Address - Country:US
Practice Address - Phone:503-747-8412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-05
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDEM-LD-10168844176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife