Provider Demographics
NPI:1336340744
Name:ROWAN, JACQUELINE ELAINE (CPM, LDEM, THW)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ELAINE
Last Name:ROWAN
Suffix:
Gender:F
Credentials:CPM, LDEM, THW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 112
Mailing Address - Street 2:
Mailing Address - City:WILLIAMS
Mailing Address - State:OR
Mailing Address - Zip Code:97544-0112
Mailing Address - Country:US
Mailing Address - Phone:541-973-8793
Mailing Address - Fax:
Practice Address - Street 1:2015 CAVES CAMP ROAD
Practice Address - Street 2:
Practice Address - City:WILLIAMS
Practice Address - State:OR
Practice Address - Zip Code:97544
Practice Address - Country:US
Practice Address - Phone:541-846-8954
Practice Address - Fax:541-846-8954
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW000110192374J00000X
ORDEM-LD-10118762175M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175M00000XOther Service ProvidersMidwife, Lay
No374J00000XNursing Service Related ProvidersDoula