Healthcare Provider Details

I. General information

NPI: 1114028826
Provider Name (Legal Business Name): NURSE MIDWIVES@ VMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 01/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4033 TALBOT RD S STE 440
RENTON WA
98055-5772
US

IV. Provider business mailing address

3600 LIND AVE SW STE 100
RENTON WA
98057-4934
US

V. Phone/Fax

Practice location:
  • Phone: 425-656-5321
  • Fax: 425-656-5319
Mailing address:
  • Phone: 425-656-5412
  • Fax: 425-656-4079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberH-155
License Number StateWA

VIII. Authorized Official

Name: MICHAEL L BERNSTEIN
Title or Position: CFO
Credential:
Phone: 425-656-5536