Healthcare Provider Details

I. General information

NPI: 1972822740
Provider Name (Legal Business Name): EMILY JOY TYDE CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY JOY DOBRA LMT

II. Dates (important events)

Enumeration Date: 05/19/2010
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 116TH AVE NE STE C
BELLEVUE WA
98004-3802
US

IV. Provider business mailing address

1813 ROCKEFELLER AVE
EVERETT WA
98201-2247
US

V. Phone/Fax

Practice location:
  • Phone: 425-451-0404
  • Fax:
Mailing address:
  • Phone: 360-447-8214
  • Fax: 360-215-3766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175M00000X
TaxonomyLay Midwife
License NumberMW61006253
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number14913
License Number StateOR
# 5
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW61006253
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: