Provider Demographics
NPI:1215346804
Name:LOPERENA MOURE, ROSEMARY (CPM, CD, CLE)
Entity type:Individual
Prefix:MISS
First Name:ROSEMARY
Middle Name:
Last Name:LOPERENA MOURE
Suffix:
Gender:F
Credentials:CPM, CD, CLE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2126 SE MADISON ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-3836
Mailing Address - Country:US
Mailing Address - Phone:939-579-3674
Mailing Address - Fax:
Practice Address - Street 1:2126 SE MADISON ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-3836
Practice Address - Country:US
Practice Address - Phone:939-579-3674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-07
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDEM-LD-10199689176B00000X
374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes176B00000XOther Service ProvidersMidwifeGroup - Single Specialty
No374J00000XNursing Service Related ProvidersDoulaGroup - Single Specialty