Provider Demographics
NPI:1609184969
Name:SPENCE, HOLLY SUE (CNM)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:SUE
Last Name:SPENCE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11750 SW BARNES ROAD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-5911
Mailing Address - Country:US
Mailing Address - Phone:503-416-9922
Mailing Address - Fax:503-416-9971
Practice Address - Street 1:11750 SW BARNES ROAD
Practice Address - Street 2:SUITE 300
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-5911
Practice Address - Country:US
Practice Address - Phone:503-416-9922
Practice Address - Fax:503-416-9971
Is Sole Proprietor?:No
Enumeration Date:2010-09-21
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA644378163WX0003X
OR201150036NP367A00000X
OR201140933RN163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient
No163W00000XNursing Service ProvidersRegistered Nurse