Healthcare Provider Details

I. General information

NPI: 1467897140
Provider Name (Legal Business Name): FOOTHILLS MIDWIFERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2013
Last Update Date: 05/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1751 COLE ST
ENUMCLAW WA
98022-3507
US

IV. Provider business mailing address

1913 WILSON AVE
ENUMCLAW WA
98022-3303
US

V. Phone/Fax

Practice location:
  • Phone: 206-227-2211
  • Fax: 206-430-6227
Mailing address:
  • Phone: 206-227-2211
  • Fax: 206-430-6227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW60325156
License Number StateWA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: TERAH LARA
Title or Position: MIDWIFE/OWNER
Credential: LM CPM
Phone: 206-227-2211