Active NPI
Mirra Leah Nerenberg, LDM,CPM, DEM
- Midwife
- Portland, OR
National Provider Identifier
1275825499
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Midwife
- License
- DEM-LD-10140879
- Practice address
- 1016 SE 12TH Ave
Portland, OR 97214 - Phone
- (503) 432-7379
- Fax
- (971) 228-1387
- NPI assigned
- May 5, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Midwife | 176B00000X | DEM-LD-10140879 | OR | Primary |
Addresses
Primary practice location
1016 SE 12TH Ave
Portland, OR 97214
Mailing address
3927 SE 64TH Ave
Portland, OR 97206
Phone (503) 432-7379
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DEM-LD-10140879 | OR | MD | Midwife |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1304553600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1510185600000",
"number": "1275825499",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3927 SE 64TH AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "97206",
"telephone_number": "503-432-7379",
"fax_number": "917-228-1387"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1016 SE 12TH AVE",
"city": "PORTLAND",
"state": "OR",
"postal_code": "97214",
"telephone_number": "503-432-7379",
"fax_number": "971-228-1387"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NERENBERG",
"first_name": "MIRRA",
"middle_name": "LEAH",
"credential": "LDM,CPM, DEM",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-05-05",
"last_updated": "2017-11-09",
"status": "A"
},
"taxonomies": [
{
"code": "176B00000X",
"taxonomy_group": "",
"desc": "Midwife",
"state": "OR",
"license": "DEM-LD-10140879",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.