Provider Demographics
NPI:1801611165
Name:LAURIE, RHIANNON JAMES (CNM)
Entity type:Individual
Prefix:
First Name:RHIANNON
Middle Name:JAMES
Last Name:LAURIE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:MICHELLE
Other - Last Name:STOLZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4616 NE 98TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-4221
Mailing Address - Country:US
Mailing Address - Phone:503-860-2076
Mailing Address - Fax:
Practice Address - Street 1:4616 NE 98TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97220-4221
Practice Address - Country:US
Practice Address - Phone:503-860-2076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10018242367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife