Provider Demographics
NPI:1609682137
Name:PORTER, EMILY (CPM)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:PORTER
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:629 BURGHARDT DR
Mailing Address - Street 2:
Mailing Address - City:MOLALLA
Mailing Address - State:OR
Mailing Address - Zip Code:97038-7588
Mailing Address - Country:US
Mailing Address - Phone:503-351-5601
Mailing Address - Fax:
Practice Address - Street 1:615 SE 1ST AVE
Practice Address - Street 2:
Practice Address - City:CANBY
Practice Address - State:OR
Practice Address - Zip Code:97013-3809
Practice Address - Country:US
Practice Address - Phone:503-263-1212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CPM24120632176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife