Provider Demographics
NPI:1134593007
Name:WHITE, EMILY J (CPM, LDM)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:J
Last Name:WHITE
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 1:35632 BREWSTER RD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OR
Mailing Address - Zip Code:97355-9452
Mailing Address - Country:US
Mailing Address - Phone:541-401-8630
Mailing Address - Fax:
Practice Address - Street 1:35632 BREWSTER RD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OR
Practice Address - Zip Code:97355-9452
Practice Address - Country:US
Practice Address - Phone:541-401-8630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-16
Last Update Date:2022-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDEM-LD-10172788176B00000X
COMWR.0000179176B00000X
ORDEM-LD-10222030176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife