Provider Demographics
NPI:1437954351
Name:WILBOURN, LAURA NICOLE (CNM)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:NICOLE
Last Name:WILBOURN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:NICOLE
Other - Last Name:SUTHERLAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12220 SW 1ST ST
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-2889
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12220 SW 1ST ST
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-2889
Practice Address - Country:US
Practice Address - Phone:888-875-7820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-14
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10029476176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife