Provider Demographics
NPI:1174938013
Name:EDMAN, STEPHANIE (CD(DONA))
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:EDMAN
Suffix:
Gender:F
Credentials:CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5203 NE 32ND PL
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97211-6915
Mailing Address - Country:US
Mailing Address - Phone:503-929-2006
Mailing Address - Fax:
Practice Address - Street 1:5203 NE 32ND PL
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97211-6915
Practice Address - Country:US
Practice Address - Phone:503-929-2006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-30
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10574374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR10574OtherDONA