Individual
CRYSTAL R DUTRA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPM, LDM
Contact information
Practice address
1130 LIBERTY ST SE STE 5, SALEM, OR 97302-4143
(503) 930-9934
Mailing address
595 15TH ST NE, SALEM, OR 97301-2615
(503) 930-9934
Taxonomy
Speciality
Code
Description
License number
State
176B00000X
Midwife
Primary
DEM-LD-10215279
OR
Other
Enumeration date
06/21/2021
Last updated
06/21/2021
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