Provider Demographics
NPI:1295781755
Name:OGBURN, CORIANNE IRENE (LDEM, CPM)
Entity type:Individual
Prefix:
First Name:CORIANNE
Middle Name:IRENE
Last Name:OGBURN
Suffix:
Gender:F
Credentials:LDEM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1102 NE NEWPORT HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-9587
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1102 NE NEWPORT HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-9587
Practice Address - Country:US
Practice Address - Phone:541-265-4455
Practice Address - Fax:541-265-4455
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDEM-LD-974819176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR297496Medicare UPIN