Healthcare Provider Details

I. General information

NPI: 1154081776
Provider Name (Legal Business Name): JULIE E SMITH LM, CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2021
Last Update Date: 12/22/2021
Certification Date: 12/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 S 3RD ST
MOUNT VERNON WA
98273-4324
US

IV. Provider business mailing address

PO BOX 3
CLEARLAKE WA
98235-0003
US

V. Phone/Fax

Practice location:
  • Phone: 360-336-5658
  • Fax:
Mailing address:
  • Phone: 206-510-9273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW61219117
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: