Healthcare Provider Details

I. General information

NPI: 1396864823
Provider Name (Legal Business Name): GREENBANK WOMEN'S CLINIC AND BIRTH CENTER, LIMITED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3455 OLD COUNTY ROAD
GREENBANK WA
98253
US

IV. Provider business mailing address

PO BOX 67
GREENBANK WA
98253-0067
US

V. Phone/Fax

Practice location:
  • Phone: 360-678-3594
  • Fax: 360-678-3594
Mailing address:
  • Phone: 360-678-3594
  • Fax: 360-678-3783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW00000126
License Number StateWA

VIII. Authorized Official

Name: MS. CYNTHIA BETH JAFFE
Title or Position: LICENSED MIDWIFE
Credential: LM
Phone: 360-678-3594