Basic Information
| Provider Information | |||||||||
| NPI: | 1578061339 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DELPOZZO | ||||||||
| FirstName: | KANYA | ||||||||
| MiddleName: | NOEL | ||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3709 N BORTHWICK AVE | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972271220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8455197479 | ||||||||
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| Practice Location | |||||||||
| Address1: | 353 DEADMOND FERRY RD | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | OR | ||||||||
| PostalCode: | 974779406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5412227750 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2018 | ||||||||
| LastUpdateDate: | 03/06/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | 201703003NP-PP | OR | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
No ID Information.