Healthcare Provider Details

I. General information

NPI: 1972974798
Provider Name (Legal Business Name): EASTSIDE MIDWIVES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2015
Last Update Date: 10/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

13128 TOTEM LAKE BLVD NE
KIRKLAND WA
98034-2953
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QB0400X
TaxonomyBirthing Clinic/Center
License NumberMW60569358
License Number StateWA

VIII. Authorized Official

Name: HEIKE HORNSBY
Title or Position: OWNER
Credential: LM, CPM
Phone: 425-823-1919