Provider Demographics
NPI:1588698187
Name:DAVIDSON, KATHERINE ELLEN S (RNP/CNM)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ELLEN S
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:RNP/CNM
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:E S
Other - Last Name:DAVIDSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RNP/CNM
Mailing Address - Street 1:1395 LIBERTY ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-4276
Mailing Address - Country:US
Mailing Address - Phone:503-399-2444
Mailing Address - Fax:503-581-3960
Practice Address - Street 1:1395 LIBERTY ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4276
Practice Address - Country:US
Practice Address - Phone:503-399-2444
Practice Address - Fax:503-581-3960
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR094000237N5 NPNM367A00000X, 363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR000846Medicaid
ORR115079Medicare PIN
OR000846Medicaid