Basic Information
| Provider Information | |||||||||
| NPI: | 1154852226 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VINING | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | WEST | ||||||||
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| Credential: | CPM, LDM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3262 MAYFIELD PL N | ||||||||
| Address2: | |||||||||
| City: | KEIZER | ||||||||
| State: | OR | ||||||||
| PostalCode: | 973036034 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4055967326 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 10566 SE WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972162809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5038551220 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2017 | ||||||||
| LastUpdateDate: | 11/04/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 176B00000X | 10195563 | OR | Y | Other Service Providers | Midwife |
No ID Information.