Provider Demographics
NPI:1598102311
Name:EVANS, MICAELA ASTER (CPM, LDM)
Entity Type:Individual
Prefix:MS
First Name:MICAELA
Middle Name:ASTER
Last Name:EVANS
Suffix:
Gender:F
Credentials:CPM, LDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 YALE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97530-9202
Mailing Address - Country:US
Mailing Address - Phone:503-729-4863
Mailing Address - Fax:
Practice Address - Street 1:3000 YALE CREEK RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97530-9202
Practice Address - Country:US
Practice Address - Phone:503-729-4863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-03
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDEM-LD-10153125176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife