Individual
LYDIA MARIAH DOUGLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPM, LDM
Contact information
Practice address
1453 REDWOOD CIR, GRANTS PASS, OR 97527-5523
(541) 916-8333
Mailing address
1453 REDWOOD CIR, GRANTS PASS, OR 97527-5523
(541) 916-8333
Taxonomy
Speciality
Code
Description
License number
State
176B00000X
Midwife
Primary
DEM-LD-10208453
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20060005
NORTH AMERICAN REGISTRY OF MIDWIVES
—
01
—
DEM-LD-10208453
OREGON STATE MIDWIFERY LICENSE NUMBER
OR
Enumeration date
06/09/2020
Last updated
06/09/2020
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