Provider Demographics
NPI:1093225575
Name:BERNARDO, CHARLI (LDM, LM, CPM)
Entity type:Individual
Prefix:
First Name:CHARLI
Middle Name:
Last Name:BERNARDO
Suffix:
Gender:
Credentials:LDM, LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4004 SE WOODSTOCK BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-7662
Mailing Address - Country:US
Mailing Address - Phone:971-361-8144
Mailing Address - Fax:503-914-1476
Practice Address - Street 1:4004 SE WOODSTOCK BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-7662
Practice Address - Country:US
Practice Address - Phone:971-361-8144
Practice Address - Fax:503-914-1476
Is Sole Proprietor?:No
Enumeration Date:2017-10-10
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDEM-LD-10186015176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
17070014OtherTHE NORTH AMERICAN REGISTRY OF MIDWIVES
ORDEM-LD-10186015OtherOREGON HEALTH LICENSING
WAMW60840343OtherWASHINGTON STATE DEPARTMENT OF HEALTH