Healthcare Provider Details

I. General information

NPI: 1073548475
Provider Name (Legal Business Name): KATHY LUCH LM, CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

926 18TH ST NO USPS
PORT TOWNSEND WA
98368-6005
US

IV. Provider business mailing address

PO BOX 1660
PORT TOWNSEND WA
98368-0130
US

V. Phone/Fax

Practice location:
  • Phone: 360-385-6667
  • Fax: 360-385-6667
Mailing address:
  • Phone: 360-385-6667
  • Fax: 360-385-6667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW00000075
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: