Individual
SHARON GLASS JONQUIL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CNM
Contact information
Practice address
2800 N VANCOUVER AVE, LEGACY MIDWIFERY CLINIC, STE 255, PORTLAND, OR 97227-1671
(503) 413-4500
Mailing address
2242 NE 11TH AVE, PORTLAND, OR 97212-4030
(503) 282-7651
Taxonomy
Speciality
Code
Description
License number
State
367A00000X
Advanced Practice Midwife
Primary
089000405N5
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
129580
—
OR
01
—
138080
PTAN
OR
Enumeration date
03/01/2006
Last updated
10/09/2008
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