Provider Demographics
NPI:1881804334
Name:COLEBROOK, AUGUSTINE F (CPM, LM)
Entity type:Individual
Prefix:MRS
First Name:AUGUSTINE
Middle Name:F
Last Name:COLEBROOK
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 SLIDE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MYRTLE CREEK
Mailing Address - State:OR
Mailing Address - Zip Code:97457-9651
Mailing Address - Country:US
Mailing Address - Phone:541-550-9692
Mailing Address - Fax:
Practice Address - Street 1:465 SLIDE CREEK RD
Practice Address - Street 2:
Practice Address - City:MYRTLE CREEK
Practice Address - State:OR
Practice Address - Zip Code:97457-9651
Practice Address - Country:US
Practice Address - Phone:541-550-9692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10119128176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife