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General NPI Number Information
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NPI Number | 1174189393
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Entity Type | Individual
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Provider Name | SIRI ANN LARSON IVERSON LM, CPM
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Gender | Female
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Dates
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Enumeration Date | 05/13/2019
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Last Update Date | 05/13/2019
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Provider Practice Location Address
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Address Line | 57 CEDAR AVE
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City | SNOHOMISH
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State | WA
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Zip | 98290-2929
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Country | US
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Telephone | 877-869-6105
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Fax |
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Provider Business Mailing Address
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Address Line | 5515 PANTHER LAKE RD
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City | SNOHOMISH
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State | WA
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Zip | 98290-9396
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Country | US
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Telephone | 253-208-5170
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 176B00000X
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Taxonomy Name | Midwife
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License Number | MW60896330
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License Number State | WA
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