Provider Demographics
NPI:1558968669
Name:FRIESEN, TAYLOR JANAE (CNM)
Entity Type:Individual
Prefix:MRS
First Name:TAYLOR
Middle Name:JANAE
Last Name:FRIESEN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
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Mailing Address - Street 1:1400 SW 5TH AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97201-5537
Mailing Address - Country:US
Mailing Address - Phone:866-617-6855
Mailing Address - Fax:503-346-8015
Practice Address - Street 1:3181 SW SAM JACKSON PARK RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3011
Practice Address - Country:US
Practice Address - Phone:503-418-4500
Practice Address - Fax:503-494-3878
Is Sole Proprietor?:No
Enumeration Date:2020-10-02
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH458904163WM0102X
OR202105302NP-PP367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR202105302NP-PPOtherNON-MEDICAID/MEDICAID