Healthcare Provider Details

I. General information

NPI: 1639474950
Provider Name (Legal Business Name): KYLA WHEELER LM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2011
Last Update Date: 01/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2808 COLBY AVE STE A
EVERETT WA
98201-3563
US

IV. Provider business mailing address

2808 COLBY AVE STE A
EVERETT WA
98201-3563
US

V. Phone/Fax

Practice location:
  • Phone: 425-317-0157
  • Fax: 425-317-0756
Mailing address:
  • Phone: 425-317-0157
  • Fax: 425-317-0756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW60169856
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: