Provider Demographics
NPI:1962778944
Name:BJORGAN, NAOMI GRACE (LM)
Entity type:Individual
Prefix:
First Name:NAOMI
Middle Name:GRACE
Last Name:BJORGAN
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6536 QUAIL CREEK RD
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-7904
Mailing Address - Country:US
Mailing Address - Phone:530-209-0603
Mailing Address - Fax:
Practice Address - Street 1:1727 SOUTH ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1812
Practice Address - Country:US
Practice Address - Phone:530-646-8143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-23
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMW60270938176B00000X
CALM465176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALM465OtherMIDWIFERY LICENSE