Healthcare Provider Details

I. General information

NPI: 1427492123
Provider Name (Legal Business Name): LITTLE MOUNTAIN MIDWIFERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2013
Last Update Date: 04/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4125 ASHWORTH AVE N
SEATTLE WA
98103-8147
US

IV. Provider business mailing address

4125 ASHWORTH AVE N
SEATTLE WA
98103-8147
US

V. Phone/Fax

Practice location:
  • Phone: 206-618-8574
  • Fax: 206-397-4473
Mailing address:
  • Phone: 206-618-8574
  • Fax: 206-397-4473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW60026404
License Number StateWA

VIII. Authorized Official

Name: BEVERLY BROWNE SCHUBERT
Title or Position: LICENSED MIDWIFE/ OWNER
Credential: LM, CPM
Phone: 206-618-8574