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General NPI Number Information
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NPI Number | 1912232992
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Entity Type | Organization
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Legal Business Name | ELEMENTAL BIRTH, LLC
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Dates
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Enumeration Date | 10/08/2009
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Last Update Date | 10/08/2009
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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 | 360-563-2662
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Provider Business Mailing Address
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Address Line | 5719 RIVERVIEW RD
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City | SNOHOMISH
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State | WA
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Zip | 98290-5013
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Country | US
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Telephone | 877-869-6105
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Fax | 360-563-2662
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Authorized Official
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Title or Position | MIDWIFE/MANAGER/OWNER
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Name | MELISSA A. DENMARK
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Credential | LM
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Telephone | 206-724-5303
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | MW00000286
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License Number State | WA
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