Basic Information
Provider Information
NPI: 1003139189
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ZAK
FirstName: MARGARET
MiddleName: R.
NamePrefix:  
NameSuffix:  
Credential: CNM
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 9340 SW BARNES ROAD
Address2: THE PRENATAL CLINIC, SUITE 102
City: PORTLAND
State: OR
PostalCode: 97225
CountryCode: US
TelephoneNumber: 5032162859
FaxNumber:  
Practice Location
Address1: 9340 SW BARNES ROAD
Address2: THE PRENATAL CLINIC, SUITE 102
City: PORTLAND
State: OR
PostalCode: 97225
CountryCode: US
TelephoneNumber: 5032162859
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/03/2010
LastUpdateDate: 09/18/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367A00000X201050132NPORY Physician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife 

ID Information
IDTypeStateIssuerDescription
50062987105OR MEDICAID


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