Provider Demographics
NPI:1962121665
Name:VERNON, PERI ROSE (CNM)
Entity type:Individual
Prefix:
First Name:PERI
Middle Name:ROSE
Last Name:VERNON
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2124 SW 28TH ST
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-8078
Mailing Address - Country:US
Mailing Address - Phone:541-647-7377
Mailing Address - Fax:
Practice Address - Street 1:2400 NE NEFF RD STE A
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6752
Practice Address - Country:US
Practice Address - Phone:541-389-3300
Practice Address - Fax:541-389-8115
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202213045NP-PP367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CNM07819OtherAMCB
OR500820093Medicaid
OR202213045NP-PPOtherOREGON STATE BOARD OF NURSING