Healthcare Provider Details

I. General information

NPI: 1396072419
Provider Name (Legal Business Name): LAKE WASHINGTON MIDWIVES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2009
Last Update Date: 11/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13128 TOTEM LAKE BLVD NE #101
KIRKLAND WA
98034-2953
US

IV. Provider business mailing address

13128 TOTEM LAKE BLVD NE #101
KIRKLAND WA
98034-2953
US

V. Phone/Fax

Practice location:
  • Phone: 425-823-1919
  • Fax: 425-823-7037
Mailing address:
  • Phone: 425-823-1919
  • Fax: 425-823-7037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BILLIE MURRAY
Title or Position: CLINIC MANAGER
Credential:
Phone: 425-823-1919