=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386079572
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DELLA VITA MIDWIFERY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/06/2013
-----------------------------------------------------
Last Update Date | 11/14/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11801 NE 65TH ST STE C
-----------------------------------------------------
City | VANCOUVER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98662-5527
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-719-2171
-----------------------------------------------------
Fax | 360-719-2172
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 16107 NE 33RD AVE
-----------------------------------------------------
City | RIDGEFIELD
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98642-9553
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 360-901-7593
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-OWNER
-----------------------------------------------------
Name | MS. BETSY CAMILLE SMITH
-----------------------------------------------------
Credential | CNM
-----------------------------------------------------
Telephone | 360-719-2171
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 367A00000X
-----------------------------------------------------
Taxonomy Name | Advanced Practice Midwife
-----------------------------------------------------
License Number | AP30007116
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 367A00000X
-----------------------------------------------------
Taxonomy Name | Advanced Practice Midwife
-----------------------------------------------------
License Number | AP30004086
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------