Provider Demographics
NPI:1528034915
Name:HAYFORD, ELIZABETH JANE (CNM)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:JANE
Last Name:HAYFORD
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:456 SE 68TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97215-1335
Mailing Address - Country:US
Mailing Address - Phone:503-257-3303
Mailing Address - Fax:
Practice Address - Street 1:2800 N VANCOUVER AVE
Practice Address - Street 2:SUITE 255
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1630
Practice Address - Country:US
Practice Address - Phone:503-413-4500
Practice Address - Fax:503-413-5222
Is Sole Proprietor?:No
Enumeration Date:2006-02-24
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR081047201N5367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR082144Medicaid
OR533625Medicare UPIN
OR130263Medicare ID - Type Unspecified