Provider Demographics
NPI:1447072889
Name:PETERSON, ABIGAIL QUINN LINDSEY (CPM)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:QUINN LINDSEY
Last Name:PETERSON
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:ABBY
Other - Middle Name:
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CPM
Mailing Address - Street 1:13160 JERUSALEM HILL RD NW
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97304-9622
Mailing Address - Country:US
Mailing Address - Phone:503-315-2229
Mailing Address - Fax:
Practice Address - Street 1:13160 JERUSALEM HILL RD NW
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97304-9622
Practice Address - Country:US
Practice Address - Phone:503-315-2229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-28
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDEM-LD-10249457176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife