Provider Demographics
NPI:1457581837
Name:CHISHOLM, ANGELA DEAN (CNM)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:DEAN
Last Name:CHISHOLM
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 1:6265 NW MOUNTAIN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-9762
Mailing Address - Country:US
Mailing Address - Phone:541-602-7935
Mailing Address - Fax:
Practice Address - Street 1:3640 NW SAMARITAN DR STE 220
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-3784
Practice Address - Country:US
Practice Address - Phone:541-768-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-21
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3015481367A00000X
OR200950093NP367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife