Provider Demographics
NPI:1619243672
Name:SHOWALTER, MARY GRACE (CNM)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:GRACE
Last Name:SHOWALTER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:MISS
Other - First Name:MARY
Other - Middle Name:GRACE
Other - Last Name:STRUBHAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM
Mailing Address - Street 1:18300 FOBERT RD NE
Mailing Address - Street 2:
Mailing Address - City:HUBBARD
Mailing Address - State:OR
Mailing Address - Zip Code:97032-9772
Mailing Address - Country:US
Mailing Address - Phone:971-338-3619
Mailing Address - Fax:503-980-7929
Practice Address - Street 1:18300 FOBERT RD NE
Practice Address - Street 2:
Practice Address - City:HUBBARD
Practice Address - State:OR
Practice Address - Zip Code:97032-9772
Practice Address - Country:US
Practice Address - Phone:971-338-3619
Practice Address - Fax:503-980-7929
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200950056NP NMNP-PP367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife