Provider Demographics
NPI:1154790863
Name:BUBAS STEVENS, KATRINA (CPM, LDM)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:BUBAS STEVENS
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 1:7304 SE 85TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97266-5712
Mailing Address - Country:US
Mailing Address - Phone:503-307-5412
Mailing Address - Fax:
Practice Address - Street 1:7304 SE 85TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97266-5712
Practice Address - Country:US
Practice Address - Phone:503-307-5412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-23
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDEM-LD-10171645176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife