Healthcare Provider Details

I. General information

NPI: 1356731988
Provider Name (Legal Business Name): REBEKAH ELIZABETH ALICE CPM, LM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2015
Last Update Date: 05/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 E 28TH AVE
SPOKANE WA
99203
US

IV. Provider business mailing address

7833 W GRIFFIN RD
CHENEY WA
99004-9675
US

V. Phone/Fax

Practice location:
  • Phone: 509-413-9093
  • Fax:
Mailing address:
  • Phone: 509-389-2690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number60516019
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: