Provider Demographics
NPI:1871779785
Name:ECHEVERIO, PAMELA (LDM)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:ECHEVERIO
Suffix:
Gender:F
Credentials:LDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1608 SE ANKENY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-1448
Mailing Address - Country:US
Mailing Address - Phone:503-233-3001
Mailing Address - Fax:
Practice Address - Street 1:1608 SE ANKENY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-1448
Practice Address - Country:US
Practice Address - Phone:503-233-3001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-10
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10112001176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife