Provider Demographics
NPI:1336464767
Name:NEST MIDWIFERY
Entity Type:Organization
Organization Name:NEST MIDWIFERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MIDWIFE/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PERRON MEDNICK
Authorized Official - Suffix:
Authorized Official - Credentials:CPM
Authorized Official - Phone:503-449-4465
Mailing Address - Street 1:2225 NE MLK BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97212-3788
Mailing Address - Country:US
Mailing Address - Phone:503-449-4465
Mailing Address - Fax:480-772-4995
Practice Address - Street 1:2225 NE MLK BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97212-3788
Practice Address - Country:US
Practice Address - Phone:503-449-4465
Practice Address - Fax:480-772-4995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDEM-LD-10129435176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty