Healthcare Provider Details

I. General information

NPI: 1306250535
Provider Name (Legal Business Name): GUMNUT BLOSSOM MIDWIFERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2014
Last Update Date: 03/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20696 BOND RD NE BLDG C, SUITE 110
POULSBO WA
98370-9015
US

IV. Provider business mailing address

20696 BOND RD NE BLDG C #110
POULSBO WA
98370-9015
US

V. Phone/Fax

Practice location:
  • Phone: 360-779-0004
  • Fax: 206-260-1261
Mailing address:
  • Phone: 360-779-0004
  • Fax: 206-260-1261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW60129702
License Number StateWA

VIII. Authorized Official

Name: MS. MARGARET LOUISA WALES
Title or Position: OWNER, MIDWIFE
Credential: LM, CPM
Phone: 206-954-2622