Healthcare Provider Details

I. General information

NPI: 1740582642
Provider Name (Legal Business Name): LAVENDER AND ROSES BIRTH & MOTHERING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2010
Last Update Date: 11/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 LOUISIANA AVE
LIBBY MT
59923-2134
US

IV. Provider business mailing address

672 MEADOW CREEK RD
BONNERS FERRY ID
83805-5610
US

V. Phone/Fax

Practice location:
  • Phone: 406-293-6262
  • Fax:
Mailing address:
  • Phone: 208-946-0640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHERRY LEE BUSHNELL
Title or Position: MIDWIFE
Credential: CPM
Phone: 208-946-0640