Provider Demographics
NPI:1578608006
Name:BRIERLY, ELIZABETH (LDM, CPM)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:BRIERLY
Suffix:
Gender:F
Credentials:LDM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 531
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:OR
Mailing Address - Zip Code:97437-0531
Mailing Address - Country:US
Mailing Address - Phone:541-968-1626
Mailing Address - Fax:
Practice Address - Street 1:24939 JEFFERSON ROAD
Practice Address - Street 2:
Practice Address - City:ELMIRA
Practice Address - State:OR
Practice Address - Zip Code:97437
Practice Address - Country:US
Practice Address - Phone:541-968-1626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDEM-LD-1000046176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR083209Medicaid