Healthcare Provider Details

I. General information

NPI: 1790554087
Provider Name (Legal Business Name): WONDERFULLY MADE MIDWIFERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2023
Last Update Date: 12/27/2023
Certification Date: 12/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 NE CENTER ST
COUPEVILLE WA
98239-3466
US

IV. Provider business mailing address

806 SILVER LAKE RD
OAK HARBOR WA
98277-7808
US

V. Phone/Fax

Practice location:
  • Phone: 360-391-5988
  • Fax:
Mailing address:
  • Phone: 360-391-5988
  • Fax: 360-639-6331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State

VIII. Authorized Official

Name: RACHELLE VONGREY
Title or Position: OWNER
Credential: APRN
Phone: 360-391-5988