Provider Demographics
NPI:1710512652
Name:WHARTON, MARIAH ROSE (CNM, DNP)
Entity Type:Individual
Prefix:DR
First Name:MARIAH
Middle Name:ROSE
Last Name:WHARTON
Suffix:
Gender:F
Credentials:CNM, DNP
Other - Prefix:MRS
Other - First Name:MARIAH
Other - Middle Name:ROSE
Other - Last Name:WHARTON-BEHNIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5340 SE MILWAUKIE AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-4800
Mailing Address - Country:US
Mailing Address - Phone:808-936-6320
Mailing Address - Fax:
Practice Address - Street 1:1406 MARINE DR
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:OR
Practice Address - Zip Code:97103-3808
Practice Address - Country:US
Practice Address - Phone:503-468-0650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-11
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201902782RN163WM0102X
CNM07986367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn