Provider Demographics
NPI:1891147294
Name:O'DUIN, LAUREN MARIE (CNM)
Entity Type:Individual
Prefix:MS
First Name:LAUREN
Middle Name:MARIE
Last Name:O'DUIN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5651 CASCADE ST
Mailing Address - Street 2:
Mailing Address - City:WEST LINN
Mailing Address - State:OR
Mailing Address - Zip Code:97068-3217
Mailing Address - Country:US
Mailing Address - Phone:503-869-3819
Mailing Address - Fax:
Practice Address - Street 1:106 SW WOODS ST STE A
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97201-4739
Practice Address - Country:US
Practice Address - Phone:406-210-4890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201704067NP-PP367A00000X
OR201406751RN163WL0100X
WAAP6068371367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAP60683731OtherARNP LICENSE