Provider Demographics
NPI:1245991322
Name:WEBSTER, SOFIA JERNSTEDT (BIRTH DOULA)
Entity type:Individual
Prefix:
First Name:SOFIA
Middle Name:JERNSTEDT
Last Name:WEBSTER
Suffix:
Gender:F
Credentials:BIRTH DOULA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1827 SE NEHEMIAH LN
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97128-9051
Mailing Address - Country:US
Mailing Address - Phone:503-536-3726
Mailing Address - Fax:
Practice Address - Street 1:1827 SE NEHEMIAH LN
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-9051
Practice Address - Country:US
Practice Address - Phone:503-536-3726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-31
Last Update Date:2021-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORTHW000105962374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORTHW000105962Medicaid