Provider Demographics
NPI:1821439407
Name:FAIRALL, PRISCILLA P (LABOR DOULA)
Entity Type:Individual
Prefix:MS
First Name:PRISCILLA
Middle Name:P
Last Name:FAIRALL
Suffix:
Gender:F
Credentials:LABOR DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 S DOWNING ST APT 18
Mailing Address - Street 2:
Mailing Address - City:SEASIDE
Mailing Address - State:OR
Mailing Address - Zip Code:97138-5510
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1021 S DOWNING ST APT 18
Practice Address - Street 2:
Practice Address - City:SEASIDE
Practice Address - State:OR
Practice Address - Zip Code:97138-5510
Practice Address - Country:US
Practice Address - Phone:360-314-7088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-11
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula