Provider Demographics
NPI:1558566745
Name:CALDWELL, PENELOPE RUTH (CNM)
Entity Type:Individual
Prefix:MRS
First Name:PENELOPE
Middle Name:RUTH
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
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Mailing Address - Street 1:847 NE 19TH AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2684
Mailing Address - Country:US
Mailing Address - Phone:503-963-2801
Mailing Address - Fax:503-996-3282
Practice Address - Street 1:5050 NE HOYT ST
Practice Address - Street 2:SUITE 353
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97213-2991
Practice Address - Country:US
Practice Address - Phone:503-239-6800
Practice Address - Fax:503-239-0006
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2015-01-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WY19617.0716367A00000X
OR201350088NP367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500672435Medicaid
OR500672435Medicaid