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General NPI Number Information
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NPI Number | 1497400162
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Entity Type | Organization
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Legal Business Name | LYNETTE M PETTIBONE, LDM, LLC
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Dates
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Enumeration Date | 02/21/2022
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Last Update Date | 02/21/2022
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Provider Practice Location Address
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Address Line | 3300 NE 54TH ST
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City | VANCOUVER
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State | WA
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Zip | 98663-1953
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Country | US
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Telephone | 206-552-0061
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Fax | 844-822-7441
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Provider Business Mailing Address
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Address Line | 7720 NE HIGHWAY 99 # D441
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City | VANCOUVER
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State | WA
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Zip | 98665-8858
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Country | US
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Telephone | 206-552-0061
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Fax | 844-822-7441
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Authorized Official
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Title or Position | MEMBER/MANAGER/DIRECTOR
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Name | LYNETTE MICHELLE PETIBONE
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Credential | LM, CPM
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Telephone | 503-443-6902
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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 |
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License Number State |
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