Provider Demographics
NPI:1578061339
Name:DELPOZZO, KANYA NOEL (CNM)
Entity Type:Individual
Prefix:
First Name:KANYA
Middle Name:NOEL
Last Name:DELPOZZO
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 1:3709 N BORTHWICK AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1220
Mailing Address - Country:US
Mailing Address - Phone:845-519-7479
Mailing Address - Fax:
Practice Address - Street 1:353 DEADMOND FERRY RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-9406
Practice Address - Country:US
Practice Address - Phone:541-222-7750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-26
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201703003NP-PP367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife