Healthcare Provider Details

I. General information

NPI: 1013483791
Provider Name (Legal Business Name): MOONRISE HEALTH AND BIRTH, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2018
Last Update Date: 06/13/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4803 219TH ST SW
MOUNTLAKE TERRACE WA
98043
US

IV. Provider business mailing address

20126 BALLINGER WAY NE # 141
SHORELINE WA
98155-1117
US

V. Phone/Fax

Practice location:
  • Phone: 425-670-6752
  • Fax: 888-691-3151
Mailing address:
  • Phone: 425-670-6752
  • Fax: 888-691-3151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175M00000X
TaxonomyLay Midwife
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number
License Number State

VIII. Authorized Official

Name: BRANDY ROSS
Title or Position: OWNER
Credential: ND, LM
Phone: 206-930-6027