Provider Demographics
NPI:1659957801
Name:NEWDELMAN, KIM (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:NEWDELMAN
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 SW MAPLECREST DR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-6422
Mailing Address - Country:US
Mailing Address - Phone:503-957-9195
Mailing Address - Fax:
Practice Address - Street 1:720 SW MAPLECREST DR
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-6422
Practice Address - Country:US
Practice Address - Phone:503-957-9276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-18
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL-153087163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation ConsultantGroup - Single Specialty