Individual
AMY JO RIST
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPM, LDM
Contact information
Practice address
2928 SE HAWTHORNE BLVD STE 107, PORTLAND, OR 97214-4147
(503) 652-8076
(503) 922-0080
Mailing address
4110 SE HAWTHORNE BLVD # 267, PORTLAND, OR 97214-5246
(503) 652-8076
(503) 922-0080
Taxonomy
Speciality
Code
Description
License number
State
176B00000X
Midwife
Primary
10151742
OR
Other
Enumeration date
11/15/2012
Last updated
11/15/2012
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