Healthcare Provider Details

I. General information

NPI: 1922641794
Provider Name (Legal Business Name): SADIE A WHITTEN LM, CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2019
Last Update Date: 10/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11314 4TH AVE W STE 108
EVERETT WA
98204-6926
US

IV. Provider business mailing address

1907 COLBY AVE
EVERETT WA
98201-2232
US

V. Phone/Fax

Practice location:
  • Phone: 425-405-0278
  • Fax:
Mailing address:
  • Phone: 425-922-7701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number61000551
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: