Healthcare Provider Details

I. General information

NPI: 1366923120
Provider Name (Legal Business Name): ORIGINS NATURAL HEALTH AND MIDWIFERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2018
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 CEDAR AVE APT 101
SNOHOMISH WA
98290-2959
US

IV. Provider business mailing address

110 CEDAR AVE APT 101
SNOHOMISH WA
98290-2959
US

V. Phone/Fax

Practice location:
  • Phone: 360-282-4014
  • Fax: 360-282-4017
Mailing address:
  • Phone: 360-282-4024
  • Fax: 360-282-4017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberMW60402527
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNT60408970
License Number StateWA

VIII. Authorized Official

Name: DR. CASSANDRA HURD
Title or Position: DOCTOR/OWNER
Credential: ND, LM, CPM
Phone: 360-862-2005