Provider Demographics
NPI:1366935306
Name:JANSEN, MAURA MAURA (CPM, LDM)
Entity type:Individual
Prefix:
First Name:MAURA
Middle Name:MAURA
Last Name:JANSEN
Suffix:
Gender:F
Credentials:CPM, LDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2124 SE OAK ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-1607
Mailing Address - Country:US
Mailing Address - Phone:503-575-8596
Mailing Address - Fax:503-334-4112
Practice Address - Street 1:7911 SE STARK ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97215-2341
Practice Address - Country:US
Practice Address - Phone:503-575-8596
Practice Address - Fax:503-334-4112
Is Sole Proprietor?:No
Enumeration Date:2018-06-13
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDEMLD10191443176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife