Healthcare Provider Details

I. General information

NPI: 1376364083
Provider Name (Legal Business Name): JODIE OWEN DOULA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2024
Last Update Date: 10/24/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 S ELM ST
COLVILLE WA
99114-2834
US

IV. Provider business mailing address

150 S ELM ST
COLVILLE WA
99114-2834
US

V. Phone/Fax

Practice location:
  • Phone: 509-684-3584
  • Fax:
Mailing address:
  • Phone: 509-684-3584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: