Provider Demographics
NPI:1851517759
Name:LEFAVE, DESIREE LYNN (CPM, LDM)
Entity type:Individual
Prefix:MRS
First Name:DESIREE
Middle Name:LYNN
Last Name:LEFAVE
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 1:408 S CENTER ST
Mailing Address - Street 2:
Mailing Address - City:NEWBERG
Mailing Address - State:OR
Mailing Address - Zip Code:97132-3553
Mailing Address - Country:US
Mailing Address - Phone:503-537-6127
Mailing Address - Fax:503-538-1033
Practice Address - Street 1:114 E HANCOCK ST
Practice Address - Street 2:
Practice Address - City:NEWBERG
Practice Address - State:OR
Practice Address - Zip Code:97132-2822
Practice Address - Country:US
Practice Address - Phone:503-538-1033
Practice Address - Fax:503-538-1033
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDEM-LD-842083175M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175M00000XOther Service ProvidersMidwife, Lay