Provider Demographics
NPI:1902319908
Name:STROOBAND, KATHLEEN LORETTA (CNM)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:LORETTA
Last Name:STROOBAND
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4240 SE KNAPP ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-8436
Mailing Address - Country:US
Mailing Address - Phone:503-757-2334
Mailing Address - Fax:
Practice Address - Street 1:4240 SE KNAPP ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97206-8436
Practice Address - Country:US
Practice Address - Phone:503-757-2334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-13
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201707002NP-PP367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife