Healthcare Provider Details

I. General information

NPI: 1306056742
Provider Name (Legal Business Name): FIRSTLIGHT MIDWIFERY CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 BROADWAY STE 200
TACOMA WA
98402-3900
US

IV. Provider business mailing address

401 BROADWAY STE 200
TACOMA WA
98402-3900
US

V. Phone/Fax

Practice location:
  • Phone: 253-973-9926
  • Fax: 253-627-5411
Mailing address:
  • Phone: 253-973-9926
  • Fax: 253-627-5411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DAWN RACHELLE WADLEIGH
Title or Position: PRESIDENT
Credential: LM CPM
Phone: 253-973-9926