Mary K Dietrich, CNM

Primary specialty

Advanced Practice MidwifeTaxonomy code 367A00000X

License

085077551N5 Issued in OR

Practice address

2705 E Burnside St
Suite 114
Portland, OR 97214-1763

Phone

(503) 215-6262

Fax

(503) 234-5437

NPI assigned

Dec 13, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Mary K Garner Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Certified Nurse Midwife

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1063573657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3178",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972083178"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2705 E BURNSIDE ST",
            "address_2": "SUITE 114",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972141763",
            "telephone_number": "503-215-6262",
            "fax_number": "503-234-5437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIETRICH",
        "first_name": "MARY",
        "middle_name": "K",
        "credential": "CNM",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "OR",
            "license": "085077551N5",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "GARNER",
            "middle_name": "K",
            "credential": "CNM",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Leslie Dieterle, B.S.
• Aline Diethelm, B.S.
• Lacy Dietle
• Grace Ann Dietrich
• Jordan Dietrich, MD
• Richard L Dietrich, D.M.D.
• Chelsie Justine Kalina Dietz, MD
• Matthew Steven Dietz, D.O.
• Jolie Rosanne Dietzen, CRNA
• Amanda Kristi Dieu, OD

• Advanced Practice Midwife in Portland, OR
• Providers in Portland, OR by specialty
• Advanced Practice Midwife in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.