Healthcare Provider Details

I. General information

NPI: 1073057089
Provider Name (Legal Business Name): BAYSIDE BIRTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2016
Last Update Date: 12/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 RUCKER AVE APT 8
EVERETT WA
98201-2791
US

IV. Provider business mailing address

2401 RUCKER AVE APT 8
EVERETT WA
98201-2791
US

V. Phone/Fax

Practice location:
  • Phone: 859-321-1560
  • Fax:
Mailing address:
  • Phone: 859-321-1560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State

VIII. Authorized Official

Name: GABRIELLA C PRICE
Title or Position: OWNER
Credential:
Phone: 859-321-1560