Healthcare Provider Details

I. General information

NPI: 1063959971
Provider Name (Legal Business Name): TIDELANDS MIDWIFERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2017
Last Update Date: 06/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4010 STONE WAY N STE 300
SEATTLE WA
98103
US

IV. Provider business mailing address

PO BOX 95234
SEATTLE WA
98145-2234
US

V. Phone/Fax

Practice location:
  • Phone: 206-348-9178
  • Fax:
Mailing address:
  • Phone: 206-348-9178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: KATHERINE SAUERLENDER
Title or Position: LICENSED MIDWIFE
Credential: LM CPM MSM
Phone: 206-348-9178