Provider Demographics
NPI:1023514601
Name:MCCLURE, SARAH JEAN (CPM LDM)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:JEAN
Last Name:MCCLURE
Suffix:
Gender:F
Credentials:CPM LDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4345 SE 47TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-4059
Mailing Address - Country:US
Mailing Address - Phone:517-614-5411
Mailing Address - Fax:
Practice Address - Street 1:4801 NE 12TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-4619
Practice Address - Country:US
Practice Address - Phone:503-914-1476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLD-10190418176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORLD-10190418OtherOREGON STATE LICENSURE