Healthcare Provider Details

I. General information

NPI: 1063897338
Provider Name (Legal Business Name): KRAAMZORG NORTHWEST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2015
Last Update Date: 07/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 NE 103RD ST
SEATTLE WA
98125-7521
US

IV. Provider business mailing address

1007 NE 103RD ST
SEATTLE WA
98125-7521
US

V. Phone/Fax

Practice location:
  • Phone: 206-375-9739
  • Fax:
Mailing address:
  • Phone: 206-375-9739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number602066133
License Number StateWA

VIII. Authorized Official

Name: JILLIAN KATE MEDFORD
Title or Position: OWNER/CERTIFIED DOULA
Credential: CPD
Phone: 206-375-9739