Provider Demographics
NPI:1144541269
Name:FLETCHER, TARRIN (CPM, LDM)
Entity type:Individual
Prefix:
First Name:TARRIN
Middle Name:
Last Name:FLETCHER
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 1:16205 SW 108TH AVE APT 319
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-4886
Mailing Address - Country:US
Mailing Address - Phone:503-781-4037
Mailing Address - Fax:503-639-6509
Practice Address - Street 1:16205 SW 108TH AVE APT 319
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-4886
Practice Address - Country:US
Practice Address - Phone:503-781-4037
Practice Address - Fax:503-639-6509
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-14
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDEM-LD-10136418176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife